COMPREHENSIVE EXAMINATION

The comprehensive examination is a process in which Dr. Betsy or Dr. Marie takes the necessary records to provide a thorough diagnosis, prognosis and treatment plan.  This examination will include a soft tissue examination of head and neck, an evaluation of the gum tissue and discussion of oral hygiene effectiveness, an examination of the bite to detect current or future orthodontic problems and a caries (cavities) examination. Drs. Betsy and Marie use both visual and radiographic examinations to locate areas of decay on chewing surfaces and between the teeth, and to monitor your child’s dental growth and development. 

PREVENTIVE SERVICES

Sealants: A sealant is a plastic material that is applied to the chewing surface of back teeth.  The material is flowed into the pits and grooves of the teeth. This acts as a barrier that protects teeth from plaques and acid, reducing the risk for decay. Sealants are not a guarantee to prevent decay, but they do significantly reduce the risk of cavities to the chewing surface. 

The teeth most at risk for decay are the six-year and twelve-year molars.  These teeth have grooves and fissures that the sealants flow into and once attached, can help to displace trapped material. Often, sealants are placed on baby or primary teeth if those teeth show any areas of vulnerability.

Fluoride Treatment: Fluoride is a mineral that is naturally present in varying amounts in foods and almost all water supplies. Fluoride is also used in many dental products such as toothpaste and mouth rinses. Fluoride acts in two ways: topically and systemically.

Topical fluorides strengthen teeth that have already erupted into the mouth. As the teeth already present in the mouth are exposed to the fluoride, this is incorporated into the outer surface of the tooth, making it more resistant to decay. Children should be receiving fluoride treatments every six months, as this is one of the most effective ways of providing the benefits of topical fluoride.  Additionally, depending on your child’s risk for decay and decay activity, Dr. Betsy and Dr. Marie may prescribe a fluoride product to use at home.

Systemic fluorides are those that are ingested through food and water and are used by the body as teeth are formed. The need for dietary fluoride supplements for the child will be determined by water supply in the child’s home.

Recare Appointment / Dental Prophylaxis: These important appointments allow Dr. Betsy, Dr. Marie and the hygienists to monitor your oral health and clean under the gumline where your toothbrush cannot reach.  They also help promote healthy gums and teeth by removing plaque that can cause decay, gum inflammation and infection.  The hygienist can assist your child with brushing and flossing.

The orientation to dental care that the hygienists perform is crucial to the development of a positive attitude to oral healthcare for most children.  Using puppetry, ‘tell, show, do” and other demonstration techniques, the hygienist can accomplish miracles even with the most tentative patient.

Mouthguards:  Custom-made mouthguards for sports activities offer comfort and communication not found in “boil and bite” commercial guards.  We offer two types of guards selected on the basis of your child’s age and level of sport intensity.  Both guards require the taking of an impression of your child’s mouth and then are custom-made in the laboratory.  A variety of wonderful colors are available.
[Back to Top]

RESTORATIVE PROCEDURES
Since most children tolerate treatment better at morning appointments, the following procedures are scheduled before lunch time.

Advances in dental materials now give us new ways to restore the cavities in your child’s teeth.  There are basically three ways to fix your child’s teeth: white colored/resin filling, silver/amalgam filling and stainless steel crowns.  There are specific situations in which each is the material of choice.

White Colored/Composite Fillings:  White-colored fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth colored restoration.  Composite fillings provide good durability and resistance to fracture in small to mid-size restorations.  Less tooth structure is removed when the dentist prepares the tooth and this may result in a smaller filling than an amalgam.  The resin is bonded or “glued” into the preparation, which can help support the tooth overall.  The major advantage of this material is the beautiful esthetic; that is they can not be seen.  The time required to place the filling is longer and requires a cavity preparation that can be kept clean and dry during filling.  Composite fillings experience similar wear to silver fillings but can be subject to stain and discoloration over time.  White fillings are hardened into place with a special curing light and require no additional time to harden.

Amalgam/Silver Fillings:  While not as common as they used to be, amalgam is still the material of choice in a variety of situations.  Dental amalgam is a compound of mercury and other metals and is often called a “silver filling” because of its appearance.  While it continues to be a commonly used restorative material, some have raised concern because of its mercury content, but their concern is unfounded.  Although mercury itself is classified as a toxic material, the mercury in amalgam chemically combines with other metals to render it stable and safe for use in fillings and restoring teeth. 

If the tooth has poorly formed, abnormal or missing enamel, the silver filling may be the material of choice.  White colored fillings are dependent on the patient having normal enamel and will fail if placed in abnormal enamel.  Silver fillings are also indicated in those situations where the filling will be under the gumline and, therefore, unable to stay dry during placement.  They are also the material of choice if the patient is uncooperative and filling placement will be difficult.  Amalgam restorations are the best material for those patients who experience sensitivity with white fillings.  Because amalgam fillings can withstand very high chewing loads, they are useful for restoring molars where chewing load is the greatest.

Stainless Steel Crowns:  A stainless steel crown is a prefabricated metal (silver) cap that fits over the entire tooth.  This is the material of choice to repair primary (baby) teeth that have been so broken down by decay or when occlusion (bite) problems are present.  Studies have shown that a SSC will last longer than a large filling.

A SSC is not the same as the crown used in adult dentistry.  These are formulated by a laboratory, require multiple visits and are made of extremely hard metals and/or porcelain.  SSC come in a variety of pre-made sizes and can be bent and shaped with special instruments to fit your child’s tooth. Thus, they require only one appointment and are a fraction of the cost.

The crown is a tooth shaped covering which protects the tooth.  It is cemented into place and is meant to be there until the primary tooth comes out.  The crown will get loose and fall out just as the natural tooth would have.  However, sticky candy (caramels, licorice, fruit roll-ups) and especially chewing gum can and will pull the crown off.  We ask that you do not allow your child to have this kind of candy or gum of any kind.

A SSC is extremely durable and does not require any further hardening.

DENTAL APPLIANCES

Space Maintainers
By age three, most children have their full set of 20 primary teeth.  The first baby tooth is usually lost around age 5-6 and the first permanent tooth appears soon thereafter.  The last baby tooth is lost around age 12.  Sometimes a baby tooth is lost early because of tooth decay or injury.  When a baby tooth is lost before the permanent tooth is ready to replace it a space is left in the mouth.  The teeth on either side of this space can tip or shift into the space left behind by the primary tooth.  Due to this tipping and shifting, when the permanent tooth is ready to come in there may not be enough room for it.  This may cause the permanent tooth to erupt crooked, crowded or prevent it from coming in at all.             

A space maintainer is used to hold the space until the permanent tooth is ready to come in.  The space maintainer is custom made to fit each individual child’s mouth.  Space maintainers are therefore unobtrusive in appearance and the patient gets used to them quickly.  The space maintainer is usually fixed into the child’s mouth and should only be removed by one of our doctors.  The type of space maintainer used is dependent on many factors including the number of missing baby teeth, the location and the individual needs of the patient.  They generally consist of a band (“ring”) around a tooth on one side of the space with a wire loop that bridges the gap to the tooth on the other side.   

The premature loss of baby teeth can lead to many problems in the future if space maintenance is not considered.  However; if space maintenance is used, excellent oral hygiene is very important.  Good oral hygiene includes flossing, brushing twice daily, and a well balanced diet.  Sticky or hard foods should be avoided to not damage or displace the appliance.  When the space maintainer is first placed it might take a few days for your child to get used to eating and talking but they soon forget it is there.

Dr. Betsy or Dr. Marie will follow the progress of the incoming permanent tooth by taking   x-rays regularly.  When the tooth is ready to come in, the space maintainer is removed.  Therefore; it is very important the patient is seen every six months.

Habit Appliances
Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Most children stop sucking on the thumbs, fingers or other objects by the time they are 2-4 years old.  Habits that persist beyond this time can cause problems with the proper growth of the mouth, tooth alignment and speech. How intensely a child sucks on fingers or thumbs will determine whether or not dental or jaw problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Intervention for thumb, finger and/or pacifier habit is recommended beyond 3 years of age

• If you are having trouble breaking your child's habit, try to:
  

• Comfort him if he is feeling insecure. Sometimes children suck their thumb for a sense of security.
  

• Instead of scolding your child for thumb sucking, praise him when he doesn't suck his thumb, especially during difficult periods.
  

• Talk to older children about what happens to the teeth and jaw if he/she does not stop and involve them in choosing the method to break the habit.
  

• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
  

• Reminders on the fingers and hands work well for some children, for example surgical tape on the appropriate finger, ace bandage or glove on the hand and fingers at night as well as the fingernail polish that tastes bad. 

If these approaches do not work in stopping your child's thumb sucking habit, we may provide you with a patient-friendly dental appliance that will break the habit.
[Back to Top]

OTHER PROCEDURES

Pulpotomy/Pulpectomy: 
A pulpotomy/pulpectomy is the partial or complete removal of nerve tissue from inside the tooth that has been contaminated with bacteria from a deep cavity or as a complication from a traumatic injury.  A soothing medication is placed inside the tooth before the final restoration is placed.

Bonding:  Bonding is the process in which tooth-colored material is applied to tooth surfaces, sculpted into shape, hardened and polished to match surrounding teeth.  With this procedure, Dr. Betsy or Dr. Marie can close gaps, repair chipped or fractured teeth and disguise discolored teeth.  Bonding is the treatment of choice for patients who have minor front tooth imperfections. Bonding usually requires one office visit. 

Tooth Whitening:  Tooth-whitening procedures offer patients with stained, discolored or dull teeth an opportunity to have a whiter, brighter smile.  Whitening significantly reduces external surface stains affected by food and beverage.  We provide two types of at-home whitening systems, which are comfortable and affordable, in conjunction with in-office appointments to monitor progress.  One system involves taking impressions of your child’s mouth to prepare the custom-fitted trays.  Then the process is completed in the comfort of your home.
[Back to Top]

 
EDUCATION

Individualized Patient Oral Care:  We consider our hygienists to be dental health educators dedicated to improving children’s oral health and preventing oral and dental disease. Our team of hygienists will work with you and your child in developing a comprehensive oral hygiene and care program that will address your child’s individual needs. For the little ones, they will teach you how to brush and floss their teeth. As your child gets older, they will teach him/her how to efficiently brush and floss on their own. They will also counsel you and your child on good nutritional habits that can prevent tooth decay. 

School Program:  Our staff is committed to public education and as a service to the community we provide dental health counseling to preschools, schools, daycare facilities, parent groups, and our fellow health care providers.  We believe that if children can see and touch our instruments, and hear our tickly toothbrush in a less threatening environment, it will make their transition to care in the office much easier.  Our school program takes approximately 20 minutes, where we will have the opportunity to interact with the group utilizing age appropriate cartoons, a puppet, and medical trinkets to demonstrate on willing participants.  Mrs. Jayna Frazier, one of our registered dental hygienists, is our Dental Health Education Coordinator.  She can work with your program director in coordinating the ideal program for your group.  All of our educational programs are free of charge.

Education for Health Care Providers:  In the fall of 2006 we started a new and exciting tradition in our practice:  The Elizabeth Mueller, D.D.S. & Associates Annual Continuing Education Seminar.  We have invited renowned speakers in the field of dentistry including Pediatric Oral Pathology and Cariology.  We feel it is our responsibility as health care providers to stay current in education and improvements in the field of dentistry.   In doing so, we take the opportunity to educate our fellow dentists and their staffs to provide the best and most up to date care for our patients.
[Back to Top]

Contact Information