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Tips from Preschool Teachers

Mar 27, 2019

This month’s blog post comes from the Mount Sinai Parenting Center, highlighting tips from preschool teachers with a combined experience of over 90 years! While the tips are broad and mostly about behavior, we found the advice to also be helpful in the dental setting! Here’s a condensed version of what the teachers had to say:

Set Expectations: Most people have a way of living up (or down) to expectations – preschoolers included. “At school we expect the kids to pour their own water at snack, to throw away their plates, to hang up their jackets – and they do,” says Jennifer Zebooker, a teacher at the 92nd street Y Nursery School, in New York City. “But then they’ll walk out of the classroom and the thumb goes in the mouth and they climb into strollers.” Raise the bar and your child will probably stretch to meet it.

  • How this applies to the dental setting: when children are little, they often sit on their parent’s lap for their dental appointment. However, as they get bigger, we strive to have them sit by themselves in the chair. We often find that children will just climb into the dental chair by themselves if you ask for them to do it… however, if you give them the choice of sitting on Mom or Dad’s lap, most kids are always going to choose their parent’s lap. Setting the expectation of sitting by yourself helps encourage independence and a successful dental visit!

Establish Predictable Routines: Kids cooperate in school because they know what’s expected of them, says Beth Cohen-Dorfman, educational coordinator at Chicago’s Concordia Avondale Campus preschool. “The children follow essentially the same routine day after day, so they quickly learn what they are supposed to be doing, and after awhile barely need reminding.” While it would be impractical to have the same level of structure at home, the more consistent you are, the more cooperative your child is likely to be, suggests Cohen-Dorfman. Decide on a few routines and stick to them: Everyone gets dressed before breakfast. When we come in from outside, we wash our hands. No bedtime stories until all kids are in jammies. Eventually, following these “house rules” will become second nature to your child.

  • How this applies to the dental setting: Consistent brushing at home should also be included in the “house rules”! Not only will consistent brushing help decrease your child’s odds of cavities, but your child will likely also do better at the dental office… after all, they are used to having someone else’s hands in their mouths!

To view the complete article (which was originally from Parents Magazine), visit here.

Is your child overdoing it with the Fluoride Toothpaste?

Feb 4, 2019

In case you missed it, the New York Times published an article on Sunday entitled “Many Children are Overdoing It on the Toothpaste, a CDC Study Says”.  And after reading it yesterday, I thought…. oh man, am I going to get questions about THIS on Monday! Sure thing… first family of the morning… “Hey Dr. Jen, what do you think about Fluoride toothpaste for kids?”

So, here are my thoughts: Fluoride toothpaste is GREAT.  And it really can help prevent cavities in kids’ teeth. So, please keep using it. However, more importantly, please make sure that you are also supervising your child during brush time! I always recommend for a parent to get a turn (or basically do the brushing) until your child can tie her own shoes, color in the lines, and/or use a fork and knife. That means until 6…7… 8 years old!  And that also means supervising the amount of Fluoride toothpaste that goes on the brush as well. Most kids like to swallow the toothpaste, especially if they are under 4 years old…  so make sure you are only putting a rice grain smear to a small pea sized amount of toothpaste on the brush, and encourage your kiddo to spit! I would recommend having the adult place the toothpaste until you are confident that your child will not sneak or squeeze the whole tube onto the brush… after all, kids’ toothpaste taste good!

Also, just to make things more confusing… the CDC and American Academy of Pediatric Dentistry have different guidelines on when to start Fluoride toothpaste (the AAPD recommends starting at age 1, and the CDC recommends at age 2).  Here’s what I think: once your child has about 12 teeth, regardless of age, please start using a rice grain smear of Fluoride toothpaste. In my opinion, once that many teeth are present, the benefits of Fluoride toothpaste outweigh the risks of not using it. And don’t forget – your child will keep his back baby molars until he is 11-13 years old, so these baby teeth are important!

If you have more questions, feel free to give us a call!

What’s up with Laughing Gas?

Dec 1, 2018

(Photo from Accutron, Inc)

One of our most helpful tools in pediatric dentistry is Nitrous Oxide, more commonly known as laughing gas. Nitrous oxide can be beneficial for any pediatric patient, but is especially helpful for children with anxiety, sensory issues, short attention spans, and even those with strong gag reflexes.  It is a mild sedative gas with a faint, pleasant aroma. When properly inhaled, it allows for your child to experience calmness and comfort.  Your child is awake the entire procedure (it does not put kids to sleep!), and while some kids may giggle with it, most tend to just enter a simple state of relaxation.

The calming effect of nitrous oxide allows our patients to maintain an appropriate level of stillness so that we can carry out procedures (like fillings!) in a safe, effective manner. It even lengthens their attention spans so that they can sit for the entirety of the visit without losing focus. As pediatric dentists, our goal is to alleviate fear and replace it with pleasant experiences. Nitrous oxide is one tool (of many) that helps us achieve this.

Pediatric dentists have an additional two to three years of training beyond dental school, where we learn to master the ins and outs of treating children in a healthy, safe, and effective manner. If you have any questions about nitrous oxide and its use, please call our office or stop in to ask!

Sources: AAPD Guidelines, Use of Nitrous Oxide for Pediatric Dental Patients. 2018.

Freeze the Sugarbugs! Is SDF a treatment option for your child?

Oct 25, 2018

We wrote about SDF – which stands for silver diamine fluoride – back in 2016 (see post here)… but due to its popularity, we thought we would touch on the subject again!

SDF is a clear, colorless antimicrobial liquid substance that’s gaining popularity in the world of pediatric dentistry (and beyond).  The topical application of SDF on teeth is a newer treatment option that allows for a quick, easy, painless, non-invasive way to combat cavities.  In the past, traditional dentistry has relied on the ‘drill and fill’ technique alone, but SDF offers a more conservative approach: stopping a cavity in its track and killing off the causative bacteria involved.

Truth be told, SDF has been around for decades in countries like Japan, Australia, and China.  The USA finally jumped on board in 2014 with an FDA approval for market.  Extensive research has been done on SDF’s mechanism of action, treatment potential, and both short-term and long-term effects.  Here at Fountain Pediatric Dentistry, we are excited to have SDF available as yet another treatment option for your child.

So how does it work? SDF’s cavity-fighting action is found in its two main ingredients: silver and fluoride.  The silver acts as an antimicrobial agent, while the fluoride promotes remineralization (healing) of the cavity itself.  During your child’s visit, SDF is applied to the dried tooth surface using a small gentle brush.  After allowing the SDF to sit and soak onto the area of the cavity for approximately one minute, the excess is removed and a fluoride varnish is used to seal in the action.  We then advise avoidance of food and drink for 30 minutes post-treatment.

Here are the primary indications for SDF in our pediatric population:

  • For the young, pre-cooperative kiddos. It may be very difficult for young children with cavities to sit for traditional treatment! In the past, sedation was the main alternative here, but now SDF can be used to ‘freeze’ or stabilize cavity lesions until these children are older and mature enough to handle traditional treatment in the chair.
  • For the special needs patients. For years, options for many special needs patients have been limited to either no treatment at all or treatment under sedation/general anesthesia.  SDF is a game changer for this group of kiddos! SDF can stabilize cavities either temporarily or permanently, depending on the type, severity, and location of lesions.  SDF can potentially allow for a complete avoidance of sedation for your special needs child.
  • For children with developmental weak spots on their teeth. Some kiddos will present with weak or ‘hypoplastic’ enamel and/or dentin on certain teeth.  These weak spots are more vulnerable to cavities, breakdown, and sensitivity.  SDF can be applied to freeze or arrest these conditions until more definitive treatment can fully protect the tooth surface.

We love SDF as a treatment option, but it’s important to remember that it’s not for everyone.  One of the main drawbacks to SDF is the post-treatment grey-black discoloration left on the tooth surface.  SDF is most often applied to posterior teeth for this reason.  We are careful to select patients who will benefit from SDF without entirely damaging the esthetics of the smile.  SDF is often thought as a temporary solution; as the child matures and is able to handle traditional treatment in the chair, a white filling may replace or be placed over the tooth to remove or mask the SDF discoloration.

We are always exploring new and innovative ways to keep your child’s oral health at its best.

Talk to us about SDF at your next visit!

References:

AAPD Guidelines on the Use of SDF for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs. 2017.

UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent (CDA Journal, Vol 44, No 1). 2016.

© 2014 Dr. Jennifer Fountain, DDS.
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