PULPOTOMY

The dental pulp has nerves and blood vessels. When the pulp is injured through tooth decay or trauma, the primary tooth can abscess. A pulpotomy is a procedure used to save a tooth when the nerve of the tooth is infected by decay or exposure. If this condition is left untreated, it may affect the bone around the developing tooth or result in facial swelling and loss of the tooth.

The treatment involves removing the infected portion of the dental pulp and cleaning, medicating and sealing the area.

In selected cases, the pulpotomy is an excellent way to save a primary tooth. After the pulpotomy treatment, a stainless steel crown is usually placed to prevent fracture of the tooth.

AESTHETIC COMPOSITE CROWN

When a front tooth is fractured or badly decayed, it may be restored with an aesthetic crown. An aesthetic crown closely matches the natural color of the other teeth. Advances in dental materials have created tooth-colored plastic crowns, which can be directly bonded to the tooth. These techniques require more time and skill of the dentist and also the full cooperation of the child.

Because these crowns are not as durable as metal, they require more care by the child.

1. Regular cleaning is needed to maintain their appearance and prevent gum irritation.
2. Avoid sticky or hard foods such as taffy, beef jerky, hard candy, carrots, apples and nuts.
3. You may cut up harder foods into bite sizes and have your child use the back teeth to chew them.
4. Avoid chewing on hard toys, nail biting or clothes fasteners (like zippers).

These composite plastic crowns can fracture or become dislodged when accidents or improper eating occurs. The child may wear through these crowns over a period of time, and they may require further repair or replacement.

SPACE MAINTAINERS

When a tooth is lost too early from an injury or abscess, other teeth may shift into the space and result in a malocclusion or bad bite.

A space maintainer is needed to hold space for the permanent teeth to come in properly after a primary, or "baby," tooth is lost early. A space maintainer for the front tooth will improve the child's appearance and may aid in proper speech development. When a permanent tooth is lost, a space maintainer is also used until a more permanent bridge can be placed.

There are several types of space maintainers:

1. Unilateral - These hold space on one side of the jaw, upper or lower.
2. Bilateral - These hold space on opposite sides of the jaw, upper and lower.
3. Anterior - These hold space for the front teeth.

These different types of space maintainers can be either removable or fixed. Removable are usually made from acrylic (plastic) and can be removed by the patient. Fixed are usually metal and are cemented and cannot be removed by the patient. The selection of the appliance is based upon your child's problem, their age and the number of teeth lost.

Instructions for the care of a space maintainer:

1. Removable appliances should be replaced in the mouth immediately after cleaning after meals; otherwise, they may be lost or damaged.
2. Fixed or cemented appliances are cared for through normal toothbrushing and flossing. Extremely hard, brittle and sticky foods are to be avoided as they may loosen the space maintainer. Loose appliances must be recemented as soon as possible to prevent breakage or decay underneath.

TOOTH EXTRACTION INSTRUCTIONS

1. Make certain that your child continues to bite on the gauze pad for 15 to 20 minutes after leaving our office. The biting pressure on the gauze pad stops the bleeding and allows better clotting.
2. Use the extra gauze we have provided when the initial gauze becomes overly wet. Fold one or two gauze pads together into fourths and place it into the extraction site. Then have your child bite firmly.
3. A slight oozing of blood for a day is normal. Call our office if there is excessive bleeding. Sometimes, a little blood mixed with saliva appears to be excessive bleeding.
4. Avoid spitting or using a straw because the sucking action may disturb the clot.
5. Avoid rinsing for one day.
6. Maintain a liquid diet for the first four hours and then a soft diet for the remainder of the day and the following day (soups, pasta, eggs, oatmeal, yogurt, gelatin, puddings, applesauce, soft cheeses, mashed potatoes, creamed spinach are examples of soft foods). Avoid hot foods.
7. Be careful and watch that your child does not accidentally bite or scratch the numb cheek, tongue or lip. It can happen very quickly! The numbness generally lasts one to two hours.
8. If there is any discomfort after the numbness wears off, give your child the appropriate dosage of acetaminophen (Tylenol) if your child is not allergic.
9. Gentle brushing and gentle rinsing with warm salt water (1 tsp. to 8 oz. glass of water) can begin the morning following extraction. A clean mouth will heal more quickly. Continue the rinsing for several days and longer if there is a problem keeping the area clean.
10. Please call our office if you have any questions or concerns.

STAINLESS STEEL CROWN

When decay has destroyed a tooth to the extent that there is little support for a filling or a nerve treatment has to be performed, it is best to cover the tooth with a crown. This will prevent the tooth from being fractured. After removal of all of the decay, a stainless steel crown is used to restore back teeth and occasionally front teeth where plastic is not easily retained.

To avoid the cost and time of replacement, please avoid sticky foods such as hard candy, caramel and taffy.

The crowned tooth will usually fall out normally when the permanent tooth is ready to come in.

SEDATION FOR THE ANXIOUS CHILD

Nitrous Oxide/Oxygen Analgesia

It is important that children remain calm and still during dental treatment to prevent injury to the child and dental staff and to receive a high quality of professional dental care. For children who are afraid, uncooperative or too young to understand dental treatment, nitrous oxide/oxygen for analgesia may be very beneficial in helping the child relax.

The following information will help parents understand sedation with the use of a combination of nitrous oxide and oxygen gases for safe analgesia.

It is very safe because the child remains alert, responsive and breathes on his/her own without assistance but may take a nap.



Much more oxygen is given than what we breathe in normal room air. This provides a wide margin for safety.



Nitrous oxide/oxygen is usually breathed through a small mask placed over the nose.



Dental treatment is more comfortable and time seems to pass faster for a relaxed child.



Sometimes known as “laughing gas” because some patients become so comfortable and relaxed, they laugh.



Often, the pediatric dentist will request that no food or drink be given to the child before treatment.



A local anesthetic is given, if needed, to numb the areas that are to be treated so that there is very little discomfort.



Oxygen is usually given at the end of treatment to remove the effects of nitrous oxide gas and end the treatment.



The child is awake and sometimes relaxed after dental treatment but will continue to feel the numbness in the treated area.

Please feel comfortable in discussing with us any other questions you may have about the procedures.

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