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Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Services & Dental Treatments 

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At Southern Smiles of NC, our Pediatric Dental Team provides regular and specialty dental care for infants, children, and teens. Our treatment options are designed around the best available techniques with an emphasis on evidence-based best practices. We endeavor to positively impact children of all ages through education on oral health and wellness, functional health of the jaws and teeth, diet, and nutrition.

Infant, Child & Teen Dental Exams 

Infant, Child & Teen Dental Exams 

An examination by the children’s dentist is recommended every six months

There are unique stages of childhood, and not every child’s growth and development occurs in the same way or at the same pace. A theme you will read and hear in our practice is that we strive to meet people where they are. As your child grows, you will notice how we conduct our dental exam, and the educational information we provide you will change. We aim to tailor the experience and the information to your child’s needs.

 

At a typical exam, we will ask if there are any updates to your child's health history and discuss any current dental concerns. The pediatric dentist will examine your child's head, neck, teeth, and Intra-oral soft tissues. The occlusion, or the way that the teeth are aligned and function together, will also be evaluated. Radiographs or X-rays will be made only if they are needed to make an accurate and complete diagnosis of your child's dental health.

The doctor will then discuss the findings from the examination and answer any questions that you have. In the event treatment is recommended for cavities/tooth decay or other issues, we will discuss the available treatment options.

 

In the event another dental specialist is needed, we will refer you to a qualified dental specialist. A dental cleaning is typically also completed at each exam; for more information, see the section on Dental Cleanings.

 

We will also discuss nutrition and the impact of a healthy mouth on the entire body.

Dental Cleanings

A regular dental cleaning is recommended every six months. Everyone on our team is a child at heart and knows how to keep it fun for the kids. Many pediatric dental practices do not have Registered Dental Hygienists licensed by the state on staff. At Southern Smiles, we do have hygienists, and we take a team approach to our dental cleanings to ensure that we are thorough and provide the best service and education. Our hygienists oversee our hygiene department, and they work in tandem with the doctor and our dental assisting team. Just as the education we provide changes depending on patient age and their stage of development, what we do during your child’s Dental Cleaning appointments also changes over time.

How we approach each child is based not only on their dental development, but also on their individual behavioral and social development

Our team progression for dental cleanings is:

Infant

Toddler

Early childhood

Middle Childhood

Pre-Teen

Teen

Dental Cleanings
Sealants

Sealants

Sealants are a protective coating bonded to the biting surface of molars and premolars that serve to keep out bacteria, plaque, and food debris. The biting surfaces of these teeth, when viewed under a microscope, are full of deep groves, pits, and fissures. The bristles of your toothbrush cannot reach into these areas to clear away the things that make it into these grooves.

 

Sealants are easy to apply and are one of the best proven low-cost measures to help keep children cavity-free. Sealants on the permanent molars are generally universally recommended and can be applied as soon as the first set of molars fully emerge, usually around age six

Before Dental Sealant

Before Dental Sealant Image - Pediatric Dentistry

After Dental Sealant

After Dental Sealant - Pediatric Dentisty
Radiographs & X-Rays
Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Radiographs & X-Rays

Dental X-rays for kids are one of the best ways to detect tooth decay and problems in teeth that are not apparent to the doctor during a visual exam of the teeth.

For more information on our safety standards and X-ray policies, CLICK HERE.

Are Radiographs, Commonly Referred ToAs “X-Rays” Safe For Your Children?

Many parents have concerns about whether X-rays are safe for their kids. At Southern Smiles, we have replaced the old manually processed X-rays and our pediatric dental team uses digital low dose x-ray technology. They are safer because they emit about 90 percent less radiation than traditional film X-rays. The dosage is so low that technically, we do not even need to use a protective apron to drape over the patient while we take the X-rays. However, we still use the protective apron to offer our families that extra peace of mind. The technology has advanced to the point where most of our X-rays are taken with a portable hand-held X-ray unit. In fact, the level of radiation from a set of digital X-rays is less than the level of radiation we’re exposed to naturally in the course of one day.

What Happens If You Decide Not To Allow X-rays?

Occasionally we have parents who will not allow us to take dental X-rays on their children. We are able to work with parents in those situations over a period of time. We will provide education and discuss why it is important to ultimately include X-rays as a part of a full evaluation for your child. Once your child has been with us for a period of about 18 months, if we have not established a level of trust with you that allows the doctor to work with the standard of care, we will help you find another dental home for your child. While X-rays are diagnostic in nature, they are also a preventative measure, helping to spot issues before they become major problems. An examination of your child’s teeth without an X-ray may not reveal potential issues with the teeth and surrounding tissue. Common problems that will go undiagnosed are: decay between the teeth, decay inside the teeth, bone infection, abscesses, missing teeth, extra teeth, impacted teeth, cysts, a variety of genetic or systemic problems, and in rare cases tumors or cancers. The Discovery of these problems at an early stage is vital for an effective plan of treatment. Without X-rays, issues not obviously apparent could go undiagnosed, resulting in progressive worsening, even to the extent of threatening your child’s overall health. Left untreated, an abscess infection can spread to other parts of the body, including the lungs, heart, and brain.

What Is A Radiograph & What Is An X-ray?

A ‘radiograph’ is the picture that is created of the teeth and supporting bone. The picture allows the dentist to essentially see through the structures of the teeth and evaluate the health of the tooth and supporting bone. The term ‘X-ray’ actually refers to the invisible electromagnetic wave that is passed through the body to create the radiograph picture. So X-rays allow us to create radiographs. The lay-person generally uses the term x-ray to describe what a dentist calls a radiograph. Don’t worry, we know how to speak in terms that make it easy for parents!

How Often Should X-Rays Be Taken?

We abide by the standards of the American Academy of Pediatric Dentistry and the ALARA principle. ALARA stands for “as low as reasonably achievable” and children should be protected from unnecessary exposure. When deciding whether a dental x-rays would be beneficial for your child, our experienced doctors will always weigh the risks against benefits. There are no exact guidelines for how often X-rays should be taken. Children who have a significant and repeated history of tooth decay will generally benefit from X-rays more often, whereas children with little or no history of tooth decay should have X-rays less often. We only recommend X-rays when they are truly beneficial and necessary to completely assess your child’s teeth.

Common Types of Pediatric Dental X-Rays

Some dental X-rays require a ‘sensor’ to be placed inside the mouth. This type of X-ray is known as an ‘intra-oral’ X-ray. Most X-rays taken in our pediatric office are of this type. These create small high-resolution images that help us focus on detecting decay and other problems. A ‘bite-wing’ X-ray and a ‘periapical’ X-ray are the two most common types. The sensors are smaller than the old-style film and are more comfortable for children.

 

Some dental X-rays are taken outside the mouth and create a larger picture that is a lower resolution and provides a very global view of the jaws, teeth, and bones of the face. These are known as ‘extraoral’ X-rays. The most common type is called a panorex or a panoramic radiograph.

Minimally Invasive Comfort Techniques

Techniques now exist in children’s dentistry that allow for minimally invasive correction of some types of dental decay. Not every situation can be solved with these newer techniques; however, there are opportunities to remove tooth decay without numbing your child (no injection of a local anesthetic) and to use higher-tech procedures that help your child get the treatment they need in a quick and comfortable fashion. Our team will be able to provide more education during your visit and discuss whether or not issues your child may have can be addressed with these techniques.

Minimally Invasive Comfort Techniques

Nitrous Oxide Sedation & Dental Anxiety

At Southern Smiles, we believe that it is vital for us to help children have the safest and most comfortable dental experience possible. It is well documented that children who have more comfortable, happy dental experiences are far more likely to grow up and adopt the healthy habit of taking care of their teeth and the healthy habit of seeing a dentist regularly in adulthood.

 

The use of nitrous oxide during dental procedures is a very effective way to relax children and help them relieve anxiety during a dental experience. We offer the latest and safest methods of offering well-controlled nitrous oxide sedation to our patients.

 

Nitrous oxide is a safe, breathable gas that is administered simultaneously with oxygen. When inhaled, the body absorbs the nitrous oxide, and it has a very calming effect. The nitrous oxide gas is eliminated from the body quickly just through breathing normally. It takes effect very quickly, and it wears off very quickly afterward.

Nitrous oxide is so effective that we are often able to fill

superficial cavities without any injection of dental anesthetic.

Is Nitrous Oxide Sedation Safe?

This is the safest form of sedation and has a long proven history of use in children. Benefits of use also include the fact that it is not addictive, your child remains fully conscious and they maintain all their normal body reflexes.

Nitrous Oxide Sedation & Dental Anxiety
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Special Instructions & Preparing Your Child For

Nitrous Oxide

There are three main considerations that are important for you to consider:

NO. 1
Recent Food Intake:

We recommend that your child does not have a full meal / full tummy inadvance of a dental appointment with nitrous oxide. In this case, there is a small chance ofnausea or vomiting if the stomach is full.

NO. 2
Breathing Issues:

Also, it is important that you update and inform the doctor and team of anyrespiratory conditions or breathing issues that your child may have, whether temporary orchronically ongoing. If your child is having difficulty breathing through the nose (commoncold, asthma, sinus problems, etc.), we need to be made aware. Breathing issues may reduce theeffectiveness of nitrous oxide & oxygen.

NO. 3
Medications:

Inform the doctor and our team the day of the dental appointment about anymedications taken within the last 24 hours, even if they are over the counter.

Are There Other Forms Of Sedation?

There are several other forms of sedation that can be administered safely; however, they are special circumstances that apply to each different level of sedation. Examples are below.

Valium (Diazepam) & Ativan (Lorazepam)

Valium and Ativan are both orally taken anti-anxiety medications. These medications help manage anxiety and provide a light sedation. This is a short-acting medication that will not cause your child to go to sleep and has a retro-amnesia effect afterward (usually results in your child forgetting the procedure altogether). These medications are absorbed in the gastro-intestinal tract and are effective within 30-60 minutes of taking the medication.

Special Instructions & PreparingYour Child For Midazolam (Versed)

  1. Eating: No solid foods after midnight the night before the appointment. NOTE: Homemade Jellois acceptable up to two hours prior to the dental appointment.

  2. Drinking: ONLY clear liquids, and no more liquids 2 hours prior to the dental appointment. Examples of approved liquid drinks: Water, clear apple juice, and sprite.

  3. Dosage: The doctor will carefully calculate the proper dosage.

  4. Other Medications: Inform the doctor and our team on the day of the dental appointment about any medications taken within the last 24 hours, even if they are over the counter.

Midazolam (Versed)

Midazolam is an orally taken anti-anxiety medication (known as Versed). This is a short-acting medication that will not cause your child to go to sleep and has a retro-amnesia effect afterward (usually results in your child forgetting the procedure altogether). This is best used for procedures that can be completed rather quickly that the child might perceive as stressful (such as removal /extraction of a baby / primary tooth). Some children may react in an agitated manner afterward, and hydrating with glucose is often helpful to calm your child). This method does not work well for procedures that will take more than about a half an hour start to finish. 

In Office IV Sedation

In certain circumstances, a deeper state of controlled sedation may be recommended. At SouthernSmiles, our pediatric doctor and team are trained in how to recognize when this level of sedation may be necessary. This is a service that we offer in collaboration with an onsite sedation anesthesiology specialist. This requires special planning and preparation by both our team and by the patient family. Our team provides patient-specific instructions and guides your preparation for this type of appointment.

Special Instructions & PreparingYour Child For Midazolam (Versed)

  1. Eating: No solid foods after midnight the night before the appointment. NOTE: Homemade Jellois acceptable up to two hours prior to the dental appointment.

  2. Drinking: ONLY clear liquids, and no more liquids 2 hours prior to the dental appointment. Examples of approved liquid drinks: Water, clear apple juice, and sprite.

  3. Dosage: The doctor will base the proper dosage on your child’s current weight. The medicine is usually a cherry-flavored liquid and is swallowed.

  4. Taking The Medication: This medicine is fast acting with a rapid onset of 15-20 minutes. The doctor will directly administer the medication.

  5. Other Medications: Inform the doctor and our team the day of the dental appointment about any medications taken within the last 24 hours, even if they are over the counter.

Hospital Or Surgical Center Sedation:

Our team provides patient-specific instructions and guides your preparation for this type of appointment. Hospital Or Surgical Center SedationIn certain circumstances a deeper state of controlled sedation may be recommended, and medical history may influence us to consider sedation in a hospital or surgical center. This requires special planning and preparation by both our team and by the patient family. Our team provides patient-specific instructions and guides your preparation for this type of appointment.

Tooth-Color/Silver Fillings,Restorations, Crowns

Tooth-Colored Fillings & Restorations:

When tooth decay is detected, and the decay can be easily removed, the shape and the structure of the decayed tooth can be restored with tooth-colored composite material. The composite material is bonded to the tooth. At Southern Smiles, we do not use the old-style silver amalgam filling material. Tooth-colored composite fillings / restorations are typically appropriate for small to medium-sized cavities and areas of decay.

Tooth-Colored & Silver Crowns:

Primary / baby teeth that have large areas of tooth decay are often best fixed by placing what is known as a “crown.” The doctor will advise you when a simple filling just won’t do and a crown is necessary. Most of the time, we will use a stainless steel silver-colored crown. These are safe, effective, and easy to place at a lower cost. They are also a more conservative way of protecting the tooth. We also offer tooth-colored crowns. However, these are typically more expensive and are not as conservative, as they require additional removal of tooth structure in order to properly make the crown.

Extraction of Baby & Permanent Teeth

Sometimes removal of teeth may be recommended. Common reasons for removal are:

  • Tooth decay that is so invasive it will be difficult or impractical to fix with a filling or a crown.

  • An abscess has formed, and there is a difficult-to-resolve infection.

  • Removal of baby teeth to relieve crowding and problems associated with the underlying permanent teeth.

  • A problem has been identified by an orthodontist, and the removal of baby teeth will help resolve it.

  • Severe crowding has been identified by an orthodontist, and the removal of permanent teeth is required in order to align the teeth and improve the bite.

Extraction of Baby & Permanent Teeth
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Nerve & Pulp Treatments

Decay and infection that penetrates into the center of a tooth where the nerve and blood vessel arehoused within the tooth can cause significant problems. The nerve tissue and blood vessels are collectively known as the ‘pulp’. There are various types of treatments that we offer to help remedy these issues. See examples to the right.

Pulpotomy: A pulpotomy is a procedure where the infected and damaged pulp tissue is removed from the upper part of the inside of the tooth. Then, any remaining tooth pulp will be treated with a special medication that helps protect the remaining pulp from infection. After this, your child's tooth will be protected with a filling or a crown, and the procedure is complete. This procedure is not always successful in every case, and some teeth eventually lose the entire blood supply and nerve tissue. Some people refer to this procedure as a ‘baby root canal,’ and this is only partially true. A true root canal procedure is significantly more invasive and requires a different technique

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Direct Pulp Cap & Indirect Pulp Cap: These procedures are even less invasive than a pulpotomy and may be appropriate to effectively treat the nerve issue with the primary tooth. Our pediatric dentist will advise parents as to which procedure is best on a case-by-case basis.

Nerve & Pulp Treatments

Traditional Fluoride Treatment

Fluoride treatments administered at regular dental checkups are one of the safest and most effective proven measures to greatly reduce the risk of dental decay. We regularly offer this service and promote safe dosage measures to protect children. Our general fluoride applications help to strengthen all teeth. We also have special fluoride treatments can be targeted to specific areas of teeth where weakened enamel is just starting to decay to stop the decay process from progressing

Traditional Fluoride Treatment

Silver Diamine Flouride (SDF)

Silver Diamine Fluoride (SDF) treatments were first introduced in the US in 2015. SDF is antimicrobial liquid that is able to treat some types of cavities in a non-invasive, fast, affordable and painless manner. SDF is a topical treatment applied by the dentist directly into the area of tooth decay. Repeated application over time is required to in order to be fully effective.

 

There are pros and cons to SDF treatment:

 

Pros:

  • Appropriate for use to stop the process of decay in teeth with small to moderate sized cavities.

  • 80% of these cavities stop forming when applied twice yearly to the forming cavity.

  • Relieves sensitivity pain related to decay.

  • Helps delay fillings being placed in teeth that are not fully.

  • Cost effective.

  • Non-invasive

 

Cons:

  • Permanently stains the cavity black.

  • 20% of cavities treated with SDF will continue to progress and grow larger.

  • If a hole has formed in a tooth, it will eventually require a filling.

 

Not an option for deep large areas of dental decay

Note: In some cases, the black staining can be masked by adding a white coating of what is known as Glass Ionomer Cement (GIC coating).

Silver Diamine Flouride

Orthodontic
Pre-Screening Exam

The following are common orthodontic problems and terms:

  • Crossbite

  • Deep Overbite

  • Openbite

  • Underbite

  • Protrusion of Incisors

  • Traumatic Bite Relationship

  • Impaction

  • Excessive Crowding

  • Excessive Spacing

  • Missing Teeth

  • Extra Teeth

  • Jaw Growth Deficiency

  • Excess Jaw Growth

Our children’s dental examination includes a basic orthodontic pre-screening evaluation. We begin this at a very early age and recommend that all children be evaluated by an orthodontist, generally between the ages of 8-9. There are certain problems that may necessitate a referral to an orthodontist at an even earlier age. Our prescreening includes evaluation of your child’s developing bite (known as the occlusion), jaw structure, and alignment of the teeth. It is important to understand that you should not wait until all the baby / primary teeth fall out before being evaluated by a qualified orthodontist. For detailed information on when a child should first be evaluated by an orthodontist and early childhood orthodontic treatment, CLICK HERE.

Pediatric Dental Trauma

Trauma to the permanent teeth and baby teeth occurs in children. Our dental team has the knowledge and experience to help guide you through what to do if trauma occurs. After significant trauma that involves knocking out a tooth or fracturing the crown of a tooth, the child needs dental care as soon as possible. For the best outcome, the child should see the dentist within 1 hour of the incident.

Pediatric Dental Trauma
Orth Prescreening Exam

First Aid For A Knocked-Out Permanent Tooth

  • Calm, quick, and decisive care is best.

  • Wear medical gloves, if available.

  • Position the child so that bleeding does not cause choking.

  • Control any bleeding.

  • Try to find the tooth.

  • If you find the tooth, DO NOT handle it by its roots.

  • If the tooth is dirty, gently rinse it with water.

  • Do not scrub or use antiseptic on the tooth.

  • Reinsert the tooth if it is a permanent tooth.

  • Do not reinsert a primary tooth.

  • Gently place the tooth back into the socket in the correct position.

  • Press down on the tooth with your thumb until the crown is level with the adjacent tooth.

  • Have the child bite down on a wad of gauze or cloth to stabilize the tooth until arrival at the dentist.

Image by Oleg Laptev

If you cannot reinsert the tooth, see the options below:

How to Transport a Knocked-Out Tooth:

For the best chance of survival for a tooth that has been knocked out, place the tooth back into the socket while waiting for dental care. If that is not possible, use one of the options below:

Milk Transport

  • Option 1 (Best): Place the tooth in a small plastic bag with some milk. Put the plastic bag in a cup of ice.

  • Option 2: Place the tooth in a cup of cold milk.

 

Saliva Transport

  • Option 1 (Use only in children older than 12 years): Put the tooth inside the child's mouth. Caution the child to be careful not to swallow it.

  • Option 2: Put the tooth in a cup. Keep the tooth moist with the child's saliva (spit).

Wet Cloth Transport

If milk and saliva are not available, wrap the tooth in a wet cloth.

 

Note: If you cannot find a knocked-out tooth, it is still important to have the child see a dentist as soon as possible. The tooth, whether permanent or primary, might be knocked up into the gums.

 

Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Additional Resources

A link to the American Academy of Pediatric Dentistry guidelines for dental trauma can be found here:

A link to the International Association of Dental Traumatology Dental Trauma Guidelines can befound here:

A link to what your pediatrician has likely been taught about how to manage dental trauma can be found here:

At Southern Smiles, we are always focused on learning the latest techniques and emphasize continuing education to ensure that our patients get the best possible treatment options!

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