We understand that children with special health care needs are unique. We have experience in providing individualized dental care to these patients.
Children with special health care needs (SHCN) may be more susceptible to oral disease due to their condition and require oral health care of a specialized nature. We have experience in providing dental care to patients with SHCN such as Autism Spectrum Disorder, Down Syndrome and Cerebral Palsy. A child with SHCN can also include patients with Amelogenesis Imperfecta, Dentinogenesis Imperfecta and oral cancer.
Children with SHCN should keep healthy teeth and gums since it is an integral part of their general health and well-being. We are dedicated to providing the best dental care to this special population.
Dental radiographs at The Bloor Clinic Kids are only taken after a thorough review of your child’s medical and dental history and after performing a careful visual examination.
Dental radiographs (e.g. X-rays) are required if the visual examination did not provide enough information to accurately diagnose decay or other dental conditions associated with your child’s teeth.
A child’s mouth develops more rapidly than an adult mouth and the baby teeth are far more susceptible to dental decay than adult teeth. It is for these reasons that children require radiographs more frequently than adults. Children at high cavity risk may require radiographs as often as every six months to detect dental decay. Children at low risk for dental decay may not require X-rays as often.
We are particularly concerned about the exposure of patients to radiation. We have appropriate safeguards such as lead aprons with thyroid collars and utilize a digital system for intra-oral radiography. Our digital radiographic system provides a reduction in radiation compared to conventional radiographs. You can be assured that your child is receiving only the necessary and minimal amount of radiation exposure if dental radiographs are required.
Dental cavities progress much faster in children, therefore dental radiographs represent a far smaller risk than undiagnosed dental problems.
General anesthetic involves the use of sedative agents administered by an experienced medical anesthesiologist, to place your child completely asleep during the dental treatment. This can be done in-office or in a hospital setting depending on each case. It may be recommended for any of several reasons, some of which are listed below:
The presence of any of the aforementioned reasons may make it difficult, if not impossible, for your child to cooperate and allow for treatment to be completed in a safe and effective manner in the dental office setting. The ultimate goal is to maintain a positive dental experience for your child, while simultaneously accomplishing the best possible treatment.
Oral sedation, commonly referred to as “conscious sedation”, involves the administration of one or more mild sedatives (in liquid form), usually in combination with nitrous oxide (laughing gas). This form of sedation allows for a more profound level of relaxation and calmness than with nitrous oxide alone, yet allows the child to remain partially awake during the procedure and have their treatment completed in our office.
The sedative(s) recommended for your child is/are dependent upon many factors, some of which include: your child’s age, your child’s weight, the presence of any medical/systemic conditions, level of anxiety, and extent of dental treatment needs before administrating any sedatives, our experienced team will educate you about the process of sedation, including preoperative and postoperative instructions. Some common side effects include nausea, vomiting, hiccups and dizziness. Some children may become more emotional after the sedation due to uninhibitied emotions. All of these side effects will fully subside when the sedative is worn off, which typically requires 2-4 hours. Recommendations made will be based upon what is in the best interest of your child.
Pediatric dentists have an in-depth knowledge of the growth and development of your child’s teeth, mouth and jaw structure. Certain growth problems, if recognized early, can be treated before they become more severe and harder to correct in the permanent dentition.
Children often exhibit signs of crowding or jaw problems as they are growing. Children between ages of 6 to 10 years are excellent candidates for early orthodontic care because it takes advantage of the patient’s physical growth potential at a stage when they are growing at a rapid rate. The primary goal of early treatment is to develop a solid foundation for the teeth.
Periodic recall appointments are set in order to check the progression of jaw growth and permanent tooth eruption. For this purpose, appliances can be utilized to direct the growth of the jaws and improve teeth alignment.
In summary, early treatment can reduce the cost, duration and complexity of comprehensive orthodontic treatment for select cases.
Thumb Sucking and Oral Habits
In the primary dentition, controlling harmful habits such as finger or thumb sucking is best done before the eruption of the permanent teeth and is also dependant on the child's willingness to stop.
The majority of children suck a thumb or a finger from a very young age. Most children stop thumb sucking on their own between the ages of two and four. They simply grow out of a habit that is no longer useful to them. However, some children continue sucking beyond the preschool years. If your child is still sucking when their permanent teeth start to erupt, it may be time to take action to break the habit.
Some dental and skeletal problems that can be caused due to prolonged oral habits include, improper jaw alignments, irregular spacing and position of the teeth, an 'open bite', cross-bites, as well as altered growth of the jaws.
In general, the treatment during the preschool period is kept simple, since the child has a limited understanding of the problem and limited ability to comply with treatment. When your child reaches the ‘mixed dentition’ stage (roughly at age six when the permanent teeth begin to erupt), it is often an excellent time for the correction of dental and skeletal problems due to persisting oral habits.
Treatment options focus on stopping the habit when the child is emotionally and psychologically ready. Fixed or removable appliances can be used to help stop the habit as well as correct any growth problems that may have arisen
When a baby molar is prematurely lost, it is often necessary to hold the teeth on either side of the missing tooth to prevent shifting and crowding. If the space is not maintained, it will be lost and there will not be enough room for the permanent tooth to erupt.
When a primary front tooth is lost, it is not necessary to place a space maintainer, as movement of adjacent teeth is not anticipated. The type of space maintainer used is dependent upon your child’s age, number of teeth lost and the stage of development.
Nitrous Oxide Sedation; more commonly known as laughing gas, can reduce anxiety and help promote relaxation while the patient remains conscious. Prior to having a dental procedure performed, Nitrous oxide and oxygen are mixed together and then inhaled through a mask that covers the nose to produce sensations of lightheadedness and a comfortable, warm-all-over feeling. Safe, effective, and non-invasive, nitrous oxide is the sedation method of choice for anxious or fearful patients.
It is advised that your child does not eat or drink anything two (2) hours prior to the appointment. Please inform us of any change to your child's health and/or medical condition. Tell us about any respiratory condition that makes breathing through the nose difficult for your child.
It may limit the effectiveness of the nitrous oxide/oxygen. Please let us know if your child is taking any medications on the day of the appointment.
The types of food we eat and how often throughout the day we eat certain foods can drastically affect the amount of tooth decay present. Often, the frequency of snacking with certain carbohydrate rich foods can be more detrimental than the total amount ingested.
After the initial consult visit, parents may be asked to keep a diet log for their children and record the types of food being eating and at what time. After careful analysis, we can isolate what factors in a child’s diet may be placing them at risk for tooth decay, as well as suggest diet plans which can optimize your child’s oral health.
Fluoride is the most effective agent available to help prevent tooth decay. It is a mineral that is naturally present in varying amounts in almost all foods and water supplies. The benefit of fluoride has been well known for over 50 years and is supported by many health and professional organizations.
Fluoride works in two ways:
Once the teeth have erupted, topical fluoride strengthens them by seeping into the outer surface of the tooth enamel, making the teeth more resistant to decay. We take in topical fluoride by using fluoride containing dental products such as toothpaste, mouth rinses, and gels.
Systemic fluoride strengthens the teeth that have erupted as well as those that are developing under the gums. We gain systemic fluoride from most foods and our community water supplies. It is also available as a supplement in liquid or gel form and can be prescribed by your dentist or physician. It is very important to monitor the amounts of fluoride a child ingests. If too much fluoride is consumed while the teeth are developing, a condition called fluorosis (white spots on the teeth) may result.
Although most people receive fluoride from food and water, sometimes it is not enough to help prevent decay. Your dentist or dental hygienist may recommend the use of home and/or professional fluoride treatments for the following risk factors:
Injuries to the teeth and jaws can be dramatically reduced through the continuous use of an athletic mouth guards worn by athletes who are engaged in contact sports. At our office, we fabricate custom made mouth guards which have better fit and comfort, are less likely to affect a child's speech, and are less likely to come loose as opposed to commercially bought mouth guards.
A sealant is a clear or tooth colored material applied to the deep grooves and pitted surfaces of a cavity-free tooth to “seal” out food and bacteria, thus reducing the risk of decay. The procedure is quick and comfortable and if properly maintained, lasts several years.
Although sealants are effective in reducing the risk of future cavities on the chewing surfaces of teeth, diligent tooth brushing and flossing is essential to ensure good oral health.
When decay has destroyed a tooth to the extent that there is little support for a filling; or when a pulpotomy has to be performed, it is essential to support the remaining tooth structure with a crown (SSC). Placing a large restoration instead of a crown will often result in fracture of the unsupported tooth structure, necessitating further dental treatment.
SSC's are most commonly placed on back teeth (molars), but occasionally may be used in the front if additional support is necessary. When the permanent tooth is ready to erupt, the SSC will exfoliate (fall out), as would a normal tooth.
A composite (tooth colored) filling is used to repair a tooth that is damaged by decay, cracks, or fractures. The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
Because composite fillings are tooth colored, they can be closely matched to the colour of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth. As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years with proper care, giving you a long lasting, beautiful smile.
It is normal to sometimes experience sensitivity to hot and cold when some composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.
How are composite fillings placed?
Composite fillings are usually placed in one appointment. While your child's tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
When a tooth has a deep cavity or has suffered a traumatic injury, bacterial infection of the nerve and blood supply to the tooth can occur. This tends to occur more often and more quickly in primary versus permanent teeth due to their thinner enamel, smaller size and relatively larger nerve. It may be necessary to cleanse and remove the infected portion of the nerve in order to save the tooth.
This is a very common procedure performed on primary teeth and after a pulpotomy has been completed, it is necessary to protect the remaining tooth structure with a stainless steel crown (cap).
There are certain circumstances where it is necessary to remove a child’s baby tooth. Certain factors such as crowding or the shape of the roots can prevent it from falling out naturally, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk of decay, so your doctor may recommend removal. Infection, orthodontic correction, or problems with a wisdom tooth may also require removal of a tooth.
When it is determined that a tooth needs to be removed, your dentist may extract the tooth during a regular checkup or may request another visit for this procedure. While this procedure is typically very quick, it is important to share with your doctor any concerns or preferences for sedation.
Once a tooth has been removed, adjacent teeth may shift, causing problems with chewing, crowding or with the function of the jaw joint. To avoid these complications, your dentist may recommend the placement of a space maintainer.