Dentists serving Derry, Londonderry, Windham, Hampstead and all of NH

• Why are my child's permanent teeth so dark compared to the baby teeth?
  Permanent teeth are usually darker than primary(baby) teeth,so against the very white baby teeth they appear dark.
• Does my child really need x-rays and why?
  Cavity finding x-rays (bitewings) should be taken once a year to check for decay between the back teeth. This will allow the cavities to be detected as soon as possible to allow for the least invasive treatment possible to be done. A panorex or full mouth x-ray is taken every three years to check for missing teeth, extra teeth developing,eruption problems or any other abnormalities that may occur.
• Why are my child's permanent teeth coming in behind the baby teeth?
  Approximately 40% of lower front permanent teeth erupt behind the baby teeth that are still in the mouth. Sometimes the baby teeth need to be helped out by the dentist.
• What is a crossbite and why correct it early?
  Typically the lower arch (mandible) is contained within the upper arch (maxilla). Sometimes the teeth in the lower arch will extend out beyond the teeth of the upper arch, either on one side or both or in the front (anterior) teeth. This should be corrected early to prevent the mandible from growing improperly to one side or forward. The earlier the correction the better stability as the years progress.
• Why does my child need a fluoride treatment twice a year at the dentist if they take fluoride at home?
  Fluoride treatments in the dental office have a much higher concentration of fluoride and therefore are highly beneficial to strengthen the teeth and help prevent decay.
• Why do I have to floss my child's or my teeth?
  Brushing alone cannot remove all the plaque in the mouth. Plaque between the teeth can only be completely removed by flossing. This will help prevent decay between the teeth.
• Why does my child have bad breath?
  Bad breath can be caused by a number of factors including decay, airway problems (tonsils, adenoids, post nasal drip, colds), gastrointestinal issues (reflux), poor oral hygiene, and bacteria on the tongue.
• What do large tonsils have to do with facial growth and teeth?
  If tonsils are very large all the time, the tongue cannot relax back into the throat so they set forward which can promote the forward growth of the mandible. This will affect the way the teeth and arches meet together.
• Why do baby teeth need to be filled?
  Baby teeth are not only needed for proper chewing but they hold the space for and help guide the permanent teeth into the proper location.
• If a back tooth is extracted, why do I need a space maintainer?
  A space maintainer will hold the space open for the permanent tooth that is unerupted. Without a space maintainer the surrounding teeth may drift forward or backward and block the spot that the permanent tooth needs to erupt.
• Why a stainless steel crown on a baby tooth instead of a porcelain crown?
  A porcelain crown is not cost efficient for a baby tooth that will be lost.
• Is a pulpotomy the same as a root canal treatment?
  No, with a pulpotomy, only the nerve in the crown of the tooth is removed.
• What is Nitrous oxide? Is it safe? Can't we try the appointment without it first?
  Nitrous oxide is a relative analgesia(medicated air) which is extremely safe and helps eliminate fear, nervousness, anxiety and helps with the gag reflex. Once a procedure is started without nitrous and a patient becomes anxious etc. especially a child, it is difficult to get the nitrous nose on and the patient will have a hard time getting themselves and their breathing under control.
• What's wrong with taking a bottle to bed or having juice(or other sugary drinks) in a sippy cup at my child's reach all the time?
  Taking a bottle to bed causes decay because the sugar in the milk or juice pools around the teeth as the child drinks and then falls asleep. The sugar mixes with the plaque, creating acid which eats away at the enamel. The same thing happens with a sippy cup containing juice, milk or other drinks that contain sugar.
• What is wrong with fruit roll-ups? Isn't there fruit in them?
  Fruit roll-ups do not have fruit in them. They are fruit flavored but are full of sugar as well as being sticky. Any sticky candy is not good for the teeth as they stay in the grooves long after they are eaten and cause decay.

Pediatric Sedation

• Nitrous Oxide
  Nitrous oxide is given through a small breathing mask which is placed over the child's nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry, recognizes this technique as a very safe, effective technique to use for treating children's dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.
  
  Prior to the appointment:
  
  

  • Nothing to eat 2-3 hours before the appointment.
  • Please inform us of any change to your child's health and/or medical condition.
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
  • Let us know if your child is taking any medication on the day of the appointment.
• Conscious Sedation
  Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, they will not be unconscious, hence the term "conscious sedation".
  
  There are a variety of different medications, which can be used for conscious sedation. The doctor will utilize the medication best suited for your child's overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.
  
  Prior to the sedation appointment:
  
  

  • Please notify us of any change in your child's health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold (any respiratory infection). Should your child become ill, contact us to see if it is necessary to reschedule the appointment.
  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
  • Please dress your child in loose fitting, comfortable clothing.
  • Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
  • Your child should not have solid food for at least 8 hours prior to their sedation appointment and only water for up to 5 hours before the appointment.
  • The child's parent or legal guardian must remain at the office during the complete procedure.
  • Please watch your child closely while the medication is taking effect. Hold them in your lap or keep them close to you. Do not leave them unattended.
  • Your child will act drowsy and may become slightly excited very soon after medication is administered.

  After the sedation appointment:
  
  

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Because we use local anesthetic to numb your child's mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
  • Please call our office for any questions or concerns that you might have.
• Outpatient General Anesthesia (O.R.)
  Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, if this is suggested for your child, the benefits of treatment this way have been deemed to outweigh the risks.
  
  Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and/or physical injury to your child in order to complete their dental treatment.
  
  The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.
  
  Prior to the O.R. appointment:
  
  

  • Please notify us of any change in your child's health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
  • Please dress your child in loose fitting, comfortable clothing.
  • Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.
  • The child's parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

  After the O.R. appointment:
  
  

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Prior to leaving the hospital/outpatient center, you will be given a detailed list of "Post-Operative Instructions" and an emergency contact number if needed.