Cleanings

The prevention of disease.

Professional cleanings (dental prophylaxis) performed by a certified dental hygienist form the foundation for preventing gum disease and tooth decay. In a professional cleaning, your hygienist will:

  • Remove plaque from the teeth — Plaque is a sticky substance that forms in the mouth from food, saliva and bacteria. Plaque sticks to teeth and causes tooth decay and gum disease.
  • Remove calculus (tartar) above the gum line — Calculus is plaque that has hardened on the tooth surface and is difficult to remove. (Calculus below the gum line indicates gum disease and requires a different procedure to remove it.)
  • Polish and remove stains from teeth.

Radiographs (x-rays)

X-rays reveal “hidden” decay.

How do X-Rays Help?

Dental x-rays or radiographs are very important. They allow the dentist to see things about your oral health that cannot be seen by the naked eye. These items include cysts (sacks of fluid that form on the roots of teeth), cancerous and non-cancerous tumors, invisible decay that occurs between teeth, and the location of teeth that haven’t grown all the way in. By using an x-ray to diagnose these problems, we can help save you money in the long run from surgeries or other treatments that might become necessary if we didn’t find the problem. In some cases, where dental x-rays show the location of tumorous growths, x-rays can be responsible for saving your life.

Are Dental X-Rays Safe?

Modern dental x-ray machines are very safe. We use only state-of-the-art, low radiation machines. The amount of radiation exposure your body receives on an airplane flight from Los Angeles to New York exceeds the amount of exposure you will receive from a modern dental x-ray machine. Contrast this minimal exposure with the risk of not finding an illness until it is too late, and you can see why we prescribe regular diagnostic x-rays.

Sealants

Proactive protection for your child’s teeth.

Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.

Even if your child brushes and flosses carefully, it is difficult (sometimes impossible) to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, reducing the risk of decay.

The application of a sealant is quick and comfortable and usually only takes only one visit. The tooth is first cleaned, then conditioned and dried. The sealant is flowed onto the grooves of the tooth and hardened with a special light. Your child will be able to eat right after the appointment.

The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. The teeth most at risk of decay, and therefore most in need of sealants, are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage. Any tooth, however, with grooves or pits may benefit from the protection of sealants. As each child’s situation is unique, Dr. Jessica will advise you when and if sealants will benefit your child. return to top

Fillings

Fillings are an effective way to restore a small amount of tooth decay.

Decay on a small portion of tooth can be resolved with a filling. A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.

Advantages/Disadvantages of composite (white) fillings:

Advantages: Composite fillings are more than just attractive. They require minimal tooth preparation, in other words less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth.

Disadvantages: The initial investment in a composite filling is higher than that for a silver filling. This is due to the fact that the composite material is more expensive and the restoration is more difficult and time consuming to place. Also, on baby teeth, with cavities in between the teeth they are more likely to have recurrent decay, thus resulting in the need for replacement.

Advantages/Disadvantages of silver fillings:

Advantages: Silver fillings have been proven to be more durable on cavities that are in between baby teeth.

Disadvantages: The obvious disadvantage is the color. Also, people have various beliefs about the metal contents in silver fillings, as they do contain a small amount of mercury. Another disadvantage is that more tooth structure needs to be removed to retain a silver filling. Thus, more healthy structure is removed that is for a composite filling.

Crowns

Crowns function to protect and keep badly decayed or fractured teeth.

A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth, which require 2 appointments, baby crowns are placed in one visit, because the tooth is prepared to fit the crown. Crowns are incredibly strong due to the fact that they are cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has had a baby root canal.

Pulpotomies (baby tooth nerve treatment)

The two common forms of pulp therapy in children’s teeth are a pulpotomy and a pulpectomy.

The pulp of the tooth is the hollow inner core of the tooth. The pulp contains nerves, blood vessels, connective tissue, and reparative cells. The purpose of pulp therapy in pediatric dentistry is to maintain the integrity of the affected tooth, so that your child’s tooth is not lost, until his/her permanent tooth is ready to erupt. Dental caries (cavities) and traumatic injury are the two main reasons for your child’s tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment,” “baby or children’s root canal,” “pulpotomy,” or “pulpectomy.”

A pulpotomy is a dental procedure that is performed when the decay in a child’s tooth reaches into the pulp (nerve) tissue. The infected part of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease (caries). Next, a sedative material is placed within the tooth to prevent bacterial growth and to calm the remaining nerve tissue.

After the pulpotomy is finished, your child’s tooth is restored with a stainless steel crown (SSC) on the back molar teeth to re-establish normal chewing function and to continue to hold the space until the permanent tooth can take its place. On the upper front teeth, either a regular stainless steel crown or a white esthetic stainless steel crown can be placed. This is performed in one visit and causes no more discomfort than placing a routine filling.

A pulpectomy is required when the entire pulp is involved. During this treatment, the diseased pulp tissue is completely removed from both the crown and the roots. The canals are cleansed, disinfected, and in the case of primary teeth filled with a resorbable material. Then a final restoration is placed which would be the same choices as for a pulpotomy on a primary tooth. A permanent tooth would be filled with a non-resorbing material and either a temporary stainless steel crown or an adult ceramic, porcelain, or gold permanent crown would by placed.

Space maintenance (maintainers)

Space maintainers hold open the empty space left by a lost tooth.

Space maintainers are appliances made of metal or plastic that is custom fit to your child’s mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.

A baby tooth usually stays in place until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, our pediatric dentists may recommend a space maintainer to prevent future space loss and dental problems.

Baby teeth are important to your child’s present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember that some baby teeth are not replaced until a child is 12 or 14 years old.

If a baby tooth is lost too soon, the neighboring teeth may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. Therefore, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.

Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It is more affordable, and easier on your child, to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.

Nitrous oxide (laughing gas)

Nitrous oxide/oxygen is a safe, effective sedative agent.

Sometimes children may feel anxious before or during treatment. Your child may need more support and a gentle caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective sedative agent used to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment.

Nitrous oxide/oxygen (N2O-O2) is a blend of two gases, oxygen and nitrous oxide. A fitted mask is placed over the nose and, as the patient breathes normally, uptake occurs through the lungs. At the end of treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects.

Your child will smell a faint sweet aroma and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness, it is often called “laughing gas.” Children sometimes report dreaming and their arms and legs may feel “tingly.” It raises the pain threshold and may even make the time appear to pass quickly. If your child is worried by the sights, sounds or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is well tolerated, has a rapid onset, is reversible, can be adjusted in various concentrations, and is non-allergenic. Your child remains fully conscious (keeps all natural reflexes) when breathing nitrous oxide/oxygen. He/she will be capable of responding to a question or request. Nitrous oxide/oxygen may also be used in combination with other sedative agents.

Dental treatment with in office IV sedation

If your child has severe anxiety, special needs or multiple area of decay requiring extensive treatment, we are fortunate to also offer IV sedation in our office with the help of Pediatric Dental Anesthesiology Associates. Under the care of a Board Certified Anesthesiologist, this is a safe and effective way to treat all dental needs in one comfortable appointment.

Here’s how it works:

  • The PDAA team comes into our office with the same medical equipment and nurses that you would find in the hospital.
  • They quickly administer an intravenous injection that works reliably within a few minutes. You may hold and comfort your child until the sedative takes effect.
  • The anesthesiologist never leaves your child’s side as they are continuously monitoring them while our dentists are focused on completing all dental work in one visit.

For more information about pediatric sedation and Timothy Watson, MD – Click Here

Dental treatment under general anesthesia (in a surgery center)

General anesthesia is controlled state of unconsciousness that eliminates awareness, movement, and discomfort during dental treatment. General anesthesia is the most involved sedative we offer at East Tennessee Pediatric Dentistry to treat dental decay, and it involves same-day surgery. All treatment is completed in a hospital operating room suite under the supervision of an anesthesiologist.

General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful, or anxious or for the very young who do not understand how to cope in a cooperative fashion. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.

Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately-trained individual in an appropriately-equipped facility. Precautions are taken to protect your child during general anesthesia; personnel who are trained to manage complications will monitor your child closely. Dr. Jessica will discuss the benefits and risks of general anesthesia and why it is recommended for your child.

A physical evaluation is required prior to general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Our office will advise you about evaluation appointments that are required.