Parent in the Operatory Policy
When you take your child to the pediatrician, you stay with them at all times; why should your visit to the pediatric dentist be any different? Dr. Matt respects that there certainly are some situations where children behave better when their parents are not in the room, however he wants parents to always feel welcomed to be with their children at all times during the course of their dental visit. Parents, please know, whether or not you want to stay with your child during the course of their dental treatment/exam is your choice.
Restraint/Papoose Board/Stabilization Wrap Policy
Dr. Matt’s policy on the use of a papoose wrap is that it should only be used in true dental emergencies such as extraction/s of infected teeth. Dr. Matt will never use the papoose wrap for routine dental procedures such as exams, cleanings, fillings, or crowns as he feels it is not safe to use a high-speed drill in the mouth of a moving, uncooperative child.
Exam/Check-Up: Infant and Toddler Exams (Children age 0-3 years old):
It is recommended that children receive their first dental visit within 6 months of the eruption of their first tooth or by their 1st birthday. Infants and toddlers are seen in a knee-to-knee position where the child remains safely on their parent’s lap and is laid-back into Dr. Matt’s lap for the duration of the exam. The cleaning and fluoride application are performed in this position as well. Once the exam is completed, Dr. Matt will review his findings with the parents as well as provide an educational foundation for basic oral hygiene instructions (toothbrushing and flossing tips), dietary recommendations, and other key concepts for ensuring your child has the best chance possible of never getting a cavity or gum disease. If you are a parent of an infant or toddler, be prepared to learn at your child’s dental visit because Dr. Matt believes parental education is one of the most important factors in ensuring children have healthy mouths and smiles as he firmly believes parents are their children’s best dentist!
Exam/Check-Up: Children 4 years and older
These visits consist of x-rays, cleaning, an exam, oral hygiene instructions, and fluoride application. Parents are encouraged to be present in the operatory during the course of the exam as Dr. Matt will review his findings with you as well as recommendations for improving your child’s oral health.
Silver Diamine Fluoride Treatment
One of dentistry’s newest and most exciting treatment materials is silver diamine fluoride (also known as “SDF”) and works wonders in the world of pediatric dentistry. It is a topical antibiotic that works upon contact with the bacteria that are causing cavities.
It’s applied with a small brush specifically only to the part of the tooth that has the cavity. Similar to naturopathic and holistic approaches to the use of colloidal silver, the silver component of SDF acts by killing the cavity-causing-bacteria upon contact and the fluoride component works to harden and fortify the remaining tooth structure. SDF is not a substitute for restoring form and function to a decayed tooth, however it can “buy us some time” and prevent the decaying tooth from getting worse. It’s ideal use is on younger, pre-cooperative-aged children with smaller cavities. The idea is that by applying SDF we can stop the cavity from getting worse and buy us some time until the child is old enough to cooperate to have the tooth restored in a typical dental setting.
The only side effects are the taste (children often dislike the metallic taste which goes away within a few minutes) and the color it turns the treated teeth (blackish grey). Once the child is old enough to have the tooth restored, all of the “black” part of the tooth is removed and the tooth is restored with a normal dental restoration.
Studies show that cavities are more likely to start wherever food gets caught, on or near our teeth. It makes sense then that the majority of cavities start in the deep grooves and fissures present on either the chewing surfaces of our teeth or in between our teeth. While it would be unhygienic to put anything between our teeth that would prevent us from flossing, we are able to place a thin, flowable resin material (think of nail polish) in the grooves of our back teeth. This prevents food from getting caught in these grooves and makes it easier for us to clean. We recommend the majority of children have sealants placed in both their first and second permanent molars to prevent cavities from occurring on the chewing surfaces of these teeth.
White Tooth-Colored Fillings
Dr. Matt prefers to use (and only uses) white tooth colored fillings instead of the metal fillings for several reasons. Aside from their esthetic benefits, they also allow him to be more conservative in regards to removing tooth structure when restoring your child’s tooth. Because metal fillings are “metal”, they are brittle and can even break if they aren’t thick enough when they’re placed. This means that in order for a metal filling to be placed, at least 2mm of tooth structure must be removed or else the filling could break when the patient bites into something. The white tooth colored fillings allow Dr. Matt to remove less tooth structure when restoring your child’s teeth and they look better too.
Stainless Steel Crowns
If Dr. Matt had his way, he would never have to place a stainless steel crown on ANY child’s tooth. He thinks they’re an eye-sore and tarnish a child’s beautiful smile. As a result, he refuses to place a stainless steel crown on any child’s front teeth; he wouldn’t use them to restore the front teeth of any of the children in his family so he’s not going to use them to restore the front teeth in your child either! There are numerous alternatives to restoring front teeth with stainless steel crowns that you can read more about in the “white crowns” section below. That being said, there is a “time and place” for restoring teeth with stainless steel crowns.
Stainless steel crowns have been used in dentistry since the late 1950’s and there’s a reason why… they work! When it comes to restoring baby teeth, there are many factors that need to be considered before proceeding with treatment; one of the main ones is the size and depth of the cavity affecting your child’s tooth. Fillings can be placed on smaller cavities, however when the cavity gets large and or extends to the nerve within the tooth, a filling will no longer adequately restore the child’s tooth.
Reasons for Restoring Back Teeth with Stainless Steel Crowns
A typical child’s mouth has 20 baby teeth; 8 of which are considered posterior or “back teeth”. While the teeth in the front are important for biting and tearing, the teeth in the back are used for chewing and are therefor subjected to greater forces than the teeth in the front. This makes it that much more important to choose a strong restorative material that won’t fail when your child is eating. Also, the back teeth are the last teeth to fall out. Children will have their back baby teeth until they are often 11-13 years old, so the restorations Dr. Matt places will often have to last several years before the tooth falls-out on it’s own. That’s a lot of wear and tear these teeth will have to weather and Dr. Matt doesn’t want your child to have to undergo multiple restorations on the same baby tooth because he placed a large filling on a tooth and it fails because it’s “too big”.
Dr. Matt only uses white crowns when restoring teeth in the front. Admittedly they aren’t as strong or durable as stainless steel crowns, but they are only used to bite and tear food; not to chew. These crowns can stain and even fail if they aren’t brushed well, twice a day by PARENTS. Children who need their front teeth restored are too young for parents to expect to provide their own adequate oral hygiene so parents with children who receive these white tooth colored crowns will need to commit to brushing their child’s teeth well every day… which is what they should be doing anyways!
Zirconia Crowns (Give Your Child a Natural-Looking Smile)
Dr. Matt is proud to offer pediatric dentistry’s newest, state of the art, innovation for parents who are interested in providing the best possible esthetic result for their child; zirconia crowns. Sprig Zirconia Crowns are arguably the best possible esthetic restoration on the market as they make your child’s teeth appear as natural and stunningly white as they did before they had a cavity and they are also plaque resistant. Unlike the plastic white crowns and fillings that easily stain and retain plaque (which is what your insurance will pay-for), these crowns will never stain and are better for the surrounding soft tissues (gums) than any other restoration (filling or crown) your child could receive.
Please let Dr. Matt or Miranda know if you are interested in having your child’s teeth restored with white zirconia crowns instead of stainless steel crowns for the teeth in the back or white plastic (composite) crowns for the teeth in the front as they are not covered by your insurance and they will discuss financing these restorations with you as you will need to have a plan to pay for these restorations out of pocket prior to the procedure.
The Types of Crowns:
- Zirconia Crown: Superior quality restoration; no plaque or staining present as the zirconia material is plaque resistant, as a result the surrounding gums are pink and healthy. (Ideal choice for restoration, but you must pay out of pocket due to the high cost of material.)
- White, Plastic Crowns: These restorations are harder to keep clean. Notice both plaque and staining (circled in red) are present along the gumline for the white plastic crowns and the natural tooth. As a result, the surrounding gums are red and inflamed. (Your insurance covers these.)
- Natural Tooth
Dr. Matt believes baby teeth should stay in your child’s mouth until they’re supposed to fall-out on their own; naturally. However, if a tooth is infected and unable to be restored or there is an infection beneath your child’s baby tooth, the tooth must be pulled. Dr. Matt only pulls teeth that have to come out!
If your child has lost teeth in the back (behind their canines or “vampire” teeth) prematurely due to infection, we need to make sure their teeth don’t move/shift and he will recommend placement of a space maintainer to hold space for the eventual eruption of their adult teeth. Placement of these space maintainers is relatively easy, it doesn’t hurt, and no “shots” are required.
Early Orthodontic Evaluation
While Dr. Matt is not an orthodontist (a dental specialist who puts “braces” on patients), it is his job to assess the growth and development of every child’s jaw during their periodic exam and to refer them to the orthodontist when treatment is recommended. The majority of children do not receive orthodontic treatment until they have lost all of their baby teeth (usually around 10-13 years of age), but some kids would benefit from the placement of braces while they are in mixed dentition (they still have some baby teeth, but they also have some adult teeth; anywhere between 8 and 10 years of age). After examining your child, Dr. Matt may recommend your child receive orthodontic treatment and will refer them to the orthodontist, Dr. Rosemarie Tan, at Big Island Smiles.
It’s normal for children to habitually use a pacifier and or suck their thumbs when they’re younger, however it becomes problematic when they are still doing it after 3 years of age. Sucking on a thumb or pacifier past this age can dramatically affect the growth and development of a child’s jaw and even alter the appearance of their face. Dr. Matt may recommend the use of one of several different types of devices that can help your child quit their pacifier or thumb-sucking habit.
Going to the dentist can be a terrifying experience; especially for children who’ve previously had traumatic experiences with another dentist. Having been traumatized by a dentist himself as a child, Dr. Matt is well aware that some children require extra “TLC” and is willing to work with families on an individual basis to help their child overcome their fear of going to the dentist through desensitization visits. These visits are usually really short (10-15 minutes) and consist of going to the dental office and incrementally exposing your child to various elements of interacting with Dr. Matt. This could be something as easy as getting them to sit in the dental chair and going up and down, holding the dental mirror in their own hands, playing with the air and water syringe, and or just talking with Dr. Matt about what scares them the most about going to the dentist. You are encouraged to ask the dental staff or Dr. Matt about these visits if you feel your child would benefit from this type of visit prior to actually receiving dental care of any kind. Dr. Matt wants all kids to feel that going to the dentist doesn’t have to be a scary experience.
Nitrous Oxide Use
It’s normal for anyone to feel anxious about having a dentist perform a dental procedure in their mouth; after all, the mouth is an intimate part of our body which is very sensitive and can be the source of a lot of pain. This angst often translates into a fearful, uncooperative child which makes it incredibly difficult for them to receive dental treatment. As a result, Dr. Matt may recommend the use of “laughing gas” (nitrous oxide) during your child’s dental treatment as laughing gas can help children relax and cooperate for their dental treatment. The use of laughing gas is incredibly safe and it’s effects can be reversed in a matter of seconds.
Use of laughing gas also helps reduce or even eliminate the “gag-reflex” on some children. This is an important consideration when attempting to restore any tooth as it is necessary to place a protective barrier over the child’s cheeks, tongue, and airway when dental restorative materials are used. Your child may not be afraid of the dental procedure being performed, but they could have a gag-reflex that prevents Dr. Matt from placing the protective barrier and safely restoring your child’s tooth so he may recommend and even insist laughing gas be used in order to safely complete your child’s intended dental treatment.
Dental Treatment at the Hospital (General Anesthesia)
It is Dr. Matt’s goal for all children to be seen in a typical dental setting for all their dental treatment needs, however there are some situations where this is not a practical or prudent course of action. In dental treatment planning, the patient’s mouth is divided into 4 quadrants; upper left, lower left, upper right, and lower right. The dentist usually will complete all the treatment needs one quadrant at a time; which in a case where the patient has teeth requiring dental treatment in all four quadrants this would mean the patient would need to be seen for dental treatment over the course of 4 separate dental visits. Children 6 years of age and older should be able to handle this many dental visits, however expecting younger children (ages 2 and a half to 5 years old) to be able to tolerate this many dental visits is often asking too much of the child.
While there are some situations where it is both safe and necessary to place a child in a papoose wrap to complete dental procedures (such as emergency extractions of infected teeth), Dr. Matt does not believe in performing routine dentistry with a child placed in a papoose wrap. In situations where a toddler or young child has extensive dental treatment needs, Dr. Matt offers parents the choice of having their child’s dental treatment completed in the safest possible setting; in an operating room at Kona Community Hospital while their child is asleep under general anesthesia and under the care of an anesthesia team. This provides Dr. Matt the freedom to perform his best possible dental treatment while the child is safely monitored by anesthesia professionals. These procedures are treated just like any other surgical procedure and the child is required to undergo a physical exam by their primary care provider prior to undergoing the surgery.
How It Works
Once your child has had a physical exam by their primary care provider and is determined to be healthy enough to undergo the surgical procedure, they will be scheduled for their surgery at Kona Community Hospital. The day of the procedure, you and your child will arrive at Kona Community Hospital and your child will be assessed one more time by medical professionals as to whether or not they are healthy enough to proceed with the surgical procedure.
Once they are checked-in and changed into their hospital gown, the nursing staff will monitor them as they’re given a medicine that will help them relax prior to the procedure. After a few minutes, they will then be escorted to the hospital operating room where a team of medical professionals will help them safely breathe into a mask containing anesthetic gas that will put them to sleep in seconds. Once your child is asleep, an intravenous (IV) line and breathing tube will be placed to ensure their safety during the procedure. Your child will not receive any “pokes” or “sticks” or “shots” from needles while they are awake.
As soon as your child is asleep and the anesthesia team has safely situated your child, Dr. Matt will proceed with a series of X-rays and complete a thorough examination of all their teeth. Upon completing the treatment plan, Dr. Matt will go “tooth-by-tooth” and complete all their necessary dental treatment at that time. The whole procedure could last anywhere from 3 to 4 hours.
Once the treatment is completed, Dr. Matt will meet with you one-on-one and provide a detailed account of all the treatment completed during the procedure on a tooth chart for you to take home. He will also provide and review written post-operative instructions and give you his personal contact information on how to get in touch with him should you have any questions or concerns moving forward.