Pediatric Dentistry

Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources are:

• Too much-fluoridated toothpaste at an early age.
• The inappropriate use of fluoride supplements.
• Hidden sources of fluoride in the child’s diet.

Two and three-year-olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets and fortified fluoride vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use a baby tooth cleanser on the toothbrush of a very young child.
• Place only a pea-sized drop of children’s toothpaste on the brush when brushing.
• Account for all sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
• Avoid giving any fluoride-containing supplements to infants until they are at least six months old.
• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

Glass ionomer cements have been used in pediatric restorative dentistry for 20 years. Their usefulness in pediatric restorative dentistry is preferential relative to other materials because of their fluoride release, chemical adhesion to tooth structure, and availability to use in a variety of clinical scenarios.

Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small nonload-bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for nonload-bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

Amalgam Fillings

Dental amalgam is a dental filling material used to fill cavities caused by tooth decay. It has been used for more than 150 years in hundreds of millions of patients around the world.

Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. The chemical properties of elemental mercury allow it to react with and bind together the silver/copper/tin alloy particles to form an amalgam.

Dental amalgam fillings are also known as “silver fillings” because of their silver-like appearance. Despite the name, “silver fillings” do contain elemental mercury.

When placing dental amalgam, the dentist first drills the tooth to remove the decay and then shapes the tooth cavity for placement of the amalgam filling. Next, under appropriate safety conditions, the dentist mixes the powdered alloy with the liquid mercury to form an amalgam putty. (These components are provided to the dentist in a capsule as shown in the graphic.) This softened amalgam putty is placed and shaped in the prepared cavity, where it rapidly hardens into a solid filling.

Children may need space maintainers if they lose a tooth early or have a baby (primary) tooth extracted due to dental decay. If either is the case, it is important to know the benefits of using a space maintainer and how it can help support your child’s dental health.

A space maintainer is an appliance that is custom-made by a dentist or orthodontist in acrylic or metal material. It can be either removable or cemented in a child’s mouth. Its purpose is to keep the space open to allow the permanent tooth to erupt and come into place. Baby teeth are important to the development of the teeth, jaw bones and muscles and help to guide permanent teeth into position when the baby teeth are lost. If a space is not maintained, then teeth can shift into the open space and orthodontic treatment may be required. Not every child who loses a baby tooth early or to dental decay requires a space maintainer; however, a professional consultation with your dentist or orthodontist should be conducted to determine if using a space maintainer is needed.

Types of Space Maintainers
There are two types of space maintainers for children, removable and fixed.

1. Removable – removable space maintainers are similar to orthodontic appliances and are usually made of acrylic. In some cases, an artificial tooth may be used to fill a space that must remain open for the unerupted tooth.
2. Fixed – there are four different kinds of fixed space maintainers: unilateral, crown and loop, distal shoe and lingual.

Mouthguards, also called mouth protectors, help cushion a blow to the face, minimizing the risk of broken teeth and injuries to your lips, tongue, face or jaw. They typically cover the upper teeth and are a great way to protect the soft tissues of your tongue, lips and cheek lining.