Dentistry For Children

Dentistry For Children: Down's Syndrome and The Dentist

2011-06-16T14:29:00.000-07:00

Dentistry For Children: Down's Syndrome and The Dentist: "Down's Syndrome children can often have a very positive and rewarding experience with the dentist. Most pedodontists and their staff ha..."

Down's Syndrome and The Dentist

2011-06-16T13:12:00.000-07:00

Down's Syndrome children can often have a very positive and rewarding experience with the dentist. Most pedodontists and their staff have completed additional training and are comfortable in dealing with those children who have special needs. However, the treatment of Down's Syndrome patients can be very difficult for the patient, parent and dentist. The manner in which treatment is accomplished will depend upon how cooperative the patient is.
An initial evaluation will include having the patient seated in a dental chair alone. If that is possible, then an oral examination is done using only fingers. If this is accomplished, a dental examination using dental instruments will take place. A prophylaxis of teeth is the next step, followed by dental radiographs.
It is possible that the patient will not be cooperative; in which case a papoose wrap is used to immobilize the patient. Parents, dental assistants or the dentist trying to physically hold a patient down can be dangerous and possible bone fractures can occur. A papoose wrap will give an even pressure restraint, a mouthprop may also be needed if a patient will not open, or keep open, their mouth. The mouth prop keeps the patient from biting on an instrument and hurting themselves.
Oral pre-medication for sedation purposes may also be needed. The best way a parent can be confident of the different treatments is to consult their dentist and understand the appropriate treatment. The worse possibility is not to visit a dentist.
There can be many other questions that pertain to a Down's Syndrome patient, but these are some generalities. The best advice for any parent of a Down's Syndrome child is to practice proper oral hygiene and see the dentist regularly.
We are dedicated to providing quality dental care to all of our patients regardless of their physical or mental capabilities. I been trained in comprehensive dental education specific to children and those patients with special needs, and have been treating these patients since 1979 and have instilled in my staff the same confidence and techniques in caring for the special child, which will insure you have a positive experience.

Cell Phone Helps Us Make Quick Decision!

2011-01-24T12:55:00.000-08:00

New technology is awesome and can help us in ways we never think of. Recently, one of our savvy mom's snapped a quick picture with her cell phone of her son's mouth injury. The injury involved one of his permanent teeth and occurred after regular business hours on a Sunday afternoon. Mom called our office and was prompted on how to reach me for after hour emergencies. Due to the quick thinking of this mom, she was able to "text" the picture to my cell phone, I then was able to assess the injury, set the mom's mind at ease, and make a decision as to whether it was necessary for them to be seen in the office immediately. This Family lived a great distance from the office, so this was a great tool for us to make a decision. Parents, please check out our web site where you will find detailed information regarding: What to do for "Knocked Out" Permenant Teeth, Fractured Teeth, Lip and Gum Lacerations as well as answers to many Frequently Asked Questions. Please also note that you may call our office anytime twenty four hours a day, seven days a week and myself or another Pedodontist will be on call for such emeregencies. It is not uncommon for us to meet patients in our office for emergencies during the evening hours or on weekends.

Mouth Ulcers.... Where do they come from?

2010-07-27T09:46:00.000-07:00

Recurrent ulcers in the mouth occur in approximately 20-40% of the US Population.
Individuals who have a decreased thickness in the lining of the mouth are more prone to these ulcers. The duration of these ulcers generally last between 7-10 days. These ulcers can occur as single or multiple lesions and do not occur on the lips or gums directly around the teeth. The most common reasons ulcers appear is from trauma or from food irritants.
Trauma such as an external hit or blow or a pencil or toothbrush scraping the in inside of the mouth can cause an ulcer. Certain foods such as chocolate, tomatoes, citrus, peanuts,coffee and strawberries just to name a few, can be irritating to the oral mucosa (inside lining of the mouth). Sodium Laurel Sulfate(SLS) a highly effective surfactant used in many cleaning products requiring the removal of residues is found in toothpaste in lower concentrations. Studies have suggested that SLS in toothpaste caused recurrent aphthous ulcers, commonly referred to as canker sores. The preliminary study "showed a statistically significant decrease in the number of ulcers from 14.3 after using the SLS containing dentifrice to 5.1 ulcers after brushing with SLS free dentifrice". So if you are experiencing recurrent mouth ulcers, try using an SLS free toothpaste such as "Biotene. For the occasional ulcer, try products such as Orabase or Colgate Total and Canker Cover to control pain. A common holistic approach often recommended by Dr. Caldwell is to use honey applied to the area several times a day.

Dental Educational Program a Success!

2010-06-02T08:26:00.001-07:00

Another successful year for Tillie the Tooth!

The dental educators from our office educated over 4000 students in Fort Bend County public and private schools this past year. With a hands-on approach and many visual aides, the students interact as they learn about good oral hygiene habits and nutrition. Tillie is a large animated Molar who presents with food and plaque on her that the students volunteer to brush off. Others are chosen to help with flossing. Nutritional snacks are discussed all in a fun and humorous way. At the end, the students are given toothbrushes and handouts to take home.

This program has been presented in area schools by Debbie Snelling, RDH and Anne Pencak RDA since 1989.

Sports Safety and Mouth

2010-05-27T08:56:00.000-07:00

We see many injuries during this time of the year that are related to contact sports, especially in those sports that do not require the players to wear mouth guards, such as baseball and basketball. It is estimated by dentists that up to 40% of dental injuries occur while playing sports. Wearing a mouth guard is the best way to prevent many of these injuries and a trip to the dentist or emergency room. Boil and Fit mouth guards are available at sporting goods stores and many new styles are available that are a much better fit than previously. Another option is to have a custom sports mouth guard made in our office. I recently spoke to our local Little League Board of Directors who agreed with my concerns of our youth's safety. Their suggestion to me was to bring the topic up with the National Board of the Little League Association. This is a topic that I am very passionate about. I am committed to spreading the word about the use of mouth guards in contact sports other than football and hockey. A mouth guard can go for miles in keeping your child's smile!

Dental Xrays for Children

2010-03-22T09:27:00.000-07:00

I am frequently asked about the necessity of Dental Xrays for children. I often tell parents who are concerned about the radiation that the exposure is less than they would recieve if they flew in an airplane. The American Academy of Pediatric Dentistry as well as the ADA have endorsed guidelines for prescribing radiographs in Children. First and foremost, the reasons for dental xrays is for the ability to detect dental decay. Taking bitewing xrays at the first dental visit is recommened if the proximal surfaces (sides) cannot be probed or seen. The frequency of Xrays depends on the child's risk for decay. I take Bitewing Xrays (cavity detecting) once a year, unless the child has recurrent decay, then I retake the Bitewings at the six month checkup. Most decay starts on the interproximal surfaces of the teeth and without detection and treatment these lesions can quickly grow in size effecting the pulp and creating the need for pulp therapy and more extensive restorations. Xrays are also needed to measure growth and development as well as rule out any abnormalities so that they can be treated early on. Detection of supernumary teeth or missing teeth early in life gives us the ability to develop a treatment plan and possibly avoid extensive or unnessary treatment later. For example, if we detect a permanent tooth is missing in a child early on, every effort is made to keep the primary tooth in place as long as possible, avoiding more expensive or complex treatment at a later date.

Approximately fifty percent of my patients develop decay between their primary teeth, so detecting decay early while it is small will be much easier and less expensive to treat overall.

Avulsed or (Knocked Out Tooth)

2010-01-20T08:07:00.000-08:00

Recently, one of my young adult patients arrived at my office promptly at 8am with his permanent tooth in hand that had been completely knocked out in a hockey game the night before. This was a neighborhood "pick up" game and the usual protective equipment was not worn. His tooth had been out of its natural environment for more than twelve hours and re-implantation of his tooth was not an option. It was hard to tell him that it was too late to re-implant the tooth, if only he would have called me immediately after the accident. Of course this young man will have a false tooth placed and most likely an implant at a later date, but there is nothing better than saving that natural tooth.
A permanent tooth that has been completely avulsed (knocked out), in most cases can be re-implanted if it is done so during the first 2-4 hours. Handle the tooth gently, place the tooth back into the socket if possible by handling the crown portion of the tooth or have the patient hold the tooth in his or her mouth (the natural environment) until seeking care. If this treatment is not an option then, gently rinse the tooth and place it in milk, or water. Avoid cleaning or rubbing the tooth as this could destroy the connective fibers that help anchor the tooth in the socket.
Seek treatment as soon as possible to increase your chances of a successful re-implantation.
My procedure for re-implantation is a dental splint with arch wire and composite for 7-10days. The splint is then removed after tooth is stable and then I refer to an Endodontist for further evaluation.

Happy Holidays !!

2009-12-09T08:40:00.000-08:00

As we approach this new decade ahead, it is a time to look back and reflect about those things that are truly important to us. Our health, families, and friendships are the true priorities in life and occasionally we must be reminded of those things we often take for granted. We are fortunate to live in a thriving and growing community such as Sugar Land. Our practice has continued to grow in many ways this year which is reflected in this monthly blog site.

I am truly thankful for the many wonderful families who entrust the dental care of their children to us. My staff and I are committed to continuing to grow within the field and offering quality pediatric dental care in a nurturing environment. I wish everyone a wonderful holiday season, a blessed and prosperous new year!

OraVerse - The New Anesthesia Reversal

2009-11-30T07:20:00.000-08:00

Your child's comfort is an important priority in our practice. So if your child dislikes the lingering numbness of local anesthesia or tends to chew their lip or cheek while being numb an innovative solution is here. Our office is now offering a new product called OraVerse®.

OraVerse is the first and only product of its kind to rapidly reverse numbness following your dental procedure so you can feel, speak, smile and drink normally about twice as fast. OraVerse can benefit adults and children six years of age or older and weighing 33 lbs or more.

I was recently asked by Novalar Pharmaceuticals to participate on the advisory board for the development of this product. It has always been my concern that a child who has had local anesthesia runs the risk of biting his or her cheeks, lip or tongue. I have seen many of these cases in my practice post operatively. We have started using this product and have seen the anesthesia time reduced by half. OraVerse is administered by injection, but is not felt by the patient since they are already numb. I am recommending this for patients who have had simple procedures done such as Restorative Fillings, but not procedures such as extractions.

If you have concerns about your child and the lingering numbness from local anesthesia, let's discuss whether OraVerse is the right choice for them during their next dental visit.

For more information, you can visit us at www.larrycaldwelldds.com or www.OraVerse.com

Important Safety Information

Following parenteral use of phentolamine at doses between 5 to 15 times higher than the recommended dose of OraVerse (phentolamine mesylate), myocardial infarction, and cerebrovascular spasm and occlusion have been reported, usually in association with marked hypotensive episodes producing shock-like states. Although such effects are uncommon with OraVerse, clinicians should be alert to the signs and symptoms of tachycardia, bradycardia, and cardiac arrhythmias, particularly in patients with a history of cardiovascular disease; as these symptoms may occur with the use of phentolamine or other alpha-adrenergic blocking agents.

New Resin Crowns for Children

2009-11-17T07:16:00.000-08:00

I have decided to share with you an article I wrote about NuSmile Resin Crowns. As these crowns were being developed several years ago, I was involved in the making of the Technique Teaching Video. This video is used to train dentists across the country the technique used in the preping and placement of these crowns. To date we have done approximately 8500 anterior and 3000 posterior NuSmile Resin Crown placements. These are a great alternative to the old techniques used to create white stainless steel crowns, where we would cut out the facial surface of the crown and place a composite resin to make the crown look white. These were not only time consuming to do, but also still showed the much of the silver of the crown along the edges. Check out more information below regarding Resin Crowns.

New Resin Crowns for Children

Resin crowns are stainless steel crowns which have a white or tooth colored resin facial surface. Resin crowns are used when a child has developed large areas of decay on his/her front teeth. This decay is usually associated with a child sleeping with a bottle and is known as "nursing bottle caries" syndrome. Until recently, there have been only two ways to restore these teeth. One way is by placing a stainless steel crown on the tooth; this is very stable and durable but is not aesthetically pleasing. These crowns sometimes remain on the teeth several years since these front teeth generally do not come out until the age of six or seven. The other way of restoring these teeth is the use of bonding. These restorations look great initially, but may discolor over time, are not as durable as the stainless steel crown, and have a tendency to break.

The new resin crowns offer the best of both types of restorations. You have the durability and longevity of stainless steel and also the aesthetically pleasing look of the tooth-colored resin front. The Resin Crown restoration requires only one appointment and is the most naturally looking crown available for children today. More recently, these crowns have become available for the back molars as well. We are happy to answer any further questions you may have regarding this new technique for your child. For more information, please feel free to call the office of Dr. Larry Caldwell at 281-565-5437.
(Written by: Larry Caldwell, DDS)

New Blog Site! Larry Caldwell, DDS Sugar Land, Texas

2009-11-12T13:37:00.000-08:00

Well, here we are in cyberspace creating the long anticipated Dentistry for Children Blog Site. We have been serving Children in Sugar Land, Texas, in far Southwest Houston for over twenty five years. I have created a new Blog Site devoted to Dentistry for Children and Those With Special Needs. I am looking forward to sharing information related to the field of Pediatric Dentistry. Look for topics about New Techniques, Prevention, Frequently Asked Questions, Sedation in Pediatric Dentistry and more. Please post your questions or topics you would like to discuss! Watch for more to come.

Dr. Larry Caldwell's Motivational Pediatric Dental Charts

2009-10-29T10:28:00.000-07:00

Dr. Larry Caldwell is commited to making every child's dental experience a positive and rewarding one. For tips on thumb sucking and tooth brushing please download our Motivational Charts at Dr. Larry Caldwells website.