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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!


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.

Tongue Ties, Lip Ties, & Frenectomies – Oh My!

Sep 21, 2018

If you’re a parent of a child under the age of 12, you’ve likely heard the terms ‘tongue-tie’ and ‘lip-tie’ in passing conversation.  This blog post is meant to educate you on the basics of tongue-ties, lip-ties, and the frenectomy procedure used to treat both conditions.  So tune in!

Let’s start with the tongue-tie or ‘ankylossia’, a congenital condition restricting the tongue’s range of motion.   We are all born with a lingual frenum, a band of tissue attaching the tongue to the floor of the mouth.  But a child with a true tongue-tie has an especially short, thick, and/or tight lingual frenum attachment. Children with a tongue-tie are less able to fully extend their tongue outwards, sideways, and upwards towards the roof of the mouth.  When they do attempt to extend the tongue, it tends to fold in on itself, appearing notched or heart-shaped. Tongue-ties may interfere with infant breastfeeding and speech/swallowing/eating patterns for older children.

A lip-tie is also a congenital condition, this time located in the upper jaw area.  Again, we are all born with a labial frenum, a band of tissue connecting the upper lip to the upper gums.  But a child with a true lip-tie has an especially short, thick, and/or tight labial frenum attachment.  A lip-tie is commonly the cause of a tight lip and/or large gap between the front teeth.  A lip-tie can sometimes make brushing between the top front teeth a sensitive experience, and can be more prone to tearing with any sort of traumatic blow to the mouth.    Finally, prominent lip-ties, like tongue-ties, can interfere with breastfeeding, specifically the ability for an infant to latch and feed well.

FYI: Both tongue and lip ties can cause poor oral hygiene.  Moving the lips and tongue out of the way are important in keeping the teeth and gums clean.  When tongue and lip-ties inhibit the normal range of motion, plaque can get trapped more easily in nooks and crannies of the mouth!

A frenectomy procedure is often the solution to a problematic tongue or lip-tie.  Although traditionally, a frenectomy involves the use of a scalpel or scissors, here at Fountain Pediatric Dentistry, we use a fabulous laser to get the job done! The frenectomy procedure involves the release of the tissue tie, and the laser allows us to do so in a way that is relatively painless and fast.  The procedure usually takes only a couple minutes! Lasers allow for a less ‘messy’ procedure and have been shown to promote more rapid healing.

If you’re wondering whether your child has a prominent tongue or lip-tie, rest assured that this is something we check for during routine visits.  The frenectomy procedure is not necessarily recommended for every child with a tie, but rather for those that present with issues in basic functionality: breastfeeding, bottle-feeding, eating, swallowing, speech, poor hygiene, and orthodontic issues.  We often work in coordination with speech therapists, orthodontists, pediatricians, oral surgeons, ENTs, and orthodontists to determine if the frenectomy procedure is beneficial and/or necessary for your child.

The goal here is to maintain a happy mouth, mind, and body.  Feel free to ask us about tongue and lip-ties at your child’s next visit!

References: mayoclinic.org, AAPD Guideline on Management Considerations for Pediatric Oral Surgery and Oral Pathology

How to have a Happy, Healthy, Cavity-Free Summer!

Jul 13, 2018

SUMMER!! It’s the word that gets the whole family in a good mood.  Summer is a time for ‘letting loose’, easing up on the typical routines, and allowing ourselves the flexibility to have fun and relax on a whole new level. BBQs, trips to the pool/beach, late nights out on town, kiddie sleepovers—what more can you ask for?

We wish you a safe and super fun summer, but we also encourage you to keep it healthy!  Yes, by exercising and staying active—luckily, this comes more naturally in the summer. But, also, and just as importantly, by maintaining a FUN, HEALTHY DIET! Our routines during the school year tend to keep our diets more disciplined, yet there is a tendency to abandon those routines when the warm weather and longer days roll around.

Here at Fountain Pediatric Dentistry, we CHALLENGE YOU to a CAVITY-FREE SUMMER!

Here are some awesome ideas to get you on track:

  • Before we get to diet, let’s not forget about our recommended brushing routine! Once in the morning for ‘good breath’, and once in the evening to keep the sugar bugs away. We challenge you to brush (and floss) 30 minutes after dinner and dessert instead of waiting before bedtime. The idea here is that you’ve ‘crossed it off your list’ and can continue to enjoy the evening without having to worry about it later on when we’re all tired out and settled into ‘lazy mode’.  IF your kiddo is really craving a last-minute snack before bedtime, we recommend non-cavity causing snacks like veggies (i.e. baby carrots, cucumbers) or cheese (i.e. string cheese), and then washing it all down with a tall cup of water.
  • Promote wholesome, healthy, CLEAN meals in your household this summer. We encourage you to incorporate lots of fresh fruits and vegetables on each plate, as well as whole grains and any good, lean sources of protein.  We recommend avoiding processed foods as much as possible. Remember, the more colorful the plate the better.  There are plenty of healthy summer meal ideas online that will make your kids excited to head to the table.   We also support the new and improved guidelines set forth by USDA’s MyPlate: choosemyplate.gov/MyPlate.  Check it out!
  • Healthy summer snacks: FRESH fruits (avoid dried fruits, fruit roll-ups, fruit snacks, etc.), FRESH veggies (try pairing with a healthy dip, i.e. hummus), olive oil-based all-natural popcorn (available in stores or easy to make at home), string-cheese, yogurt, and nuts.
  • Beware of the not-so-healthy go-to snacks (consume in moderation): pretzels, Goldfish, crackers, chips. We call these the ‘sneaky snacks’, because, although they seem harmless, they have been shown to cause cavities the same way as candy! Crazy, we know.  Simple carbohydrate snacks stick into the grooves of your teeth, break down into sugars, and become a feast for cavity-causing bacteria living in your mouth.  If you choose to buy these snacks, we recommend the whole grain or multigrain versions, which are less appealing to cavity-causing bacteria.
  • The celebrated summer snacks (consume in moderation): ice cream, ice pops, milkshakes, and smoothies. Who can say no to these delicious treats on a hot summer day? Go ahead and enjoy these foods, but remember that they are high in sugar content and that consuming them too much or too frequently can do a lot of damage to the teeth (and body).
  • Drink LOTS of water!! This is important especially in the summer, when our eating routines may be a little out of whack.   Water is a natural cleanser for our mouths and overall bodies.  Keeping a ‘wet’, hydrated mouth will help wash away meal/snack leftovers AND lower the overall activity of cavity-causing bacteria (aka ‘sugar bugs’) by neutralizing the acidity level in our mouths.  Many marketing companies are promoting ‘flavored’ waters, but here at Fountain Pediatric Dentistry, we recommend just plain ol’ water.  Some ideas to make water-drinking more appealing is by making your water jug or glass more colorful with cucumber slices or mint leaves.  Avoid adding lemon (for its acidity) and sugary fruits (we don’t want our teeth soaking in sugar water).  Another idea is buying your kiddos playful summer water bottles with cool straws or special designs on them.

We hope you found these ideas helpful. AND WE HOPE YOU HAVE A WONDERFUL SUMMER!

© 2014 Dr. Jennifer Fountain, DDS.
All rights reserved.