Common Procedures
Topics on this page
Regular Exams and Cleanings
Regular exams are an important part of maintaining your child's oral health. During your child’s regular exam, we will:
- Check for any problems that may not be seen or felt
- Look for cavities or any other signs of tooth decay
- Inspect the teeth and gums for gingivitis and signs of periodontal disease
- Perform a thorough teeth cleaning
Your child’s exam will take about 30-40 minutes. Each regular exam includes a detailed teeth cleaning, in which we will clean, polish, and rinse the teeth to remove any tartar and plaque that have built up on the tooth’s surface.
Visiting our office every six months gives you the chance to talk to the doctor about any questions you may have about your child’s oral health. Regular exams are offered by appointment only, so please contact our practice today to schedule your child’s next dental exam and teeth cleaning.
Fluoride
Fluoride is effective in preventing cavities and tooth decay and in preventing plaque from building up and hardening on the tooth’s surface. A fluoride treatment in a dentist’s office takes just a few minutes. After the treatment, your child may be asked not to eat hard food, drink hot beverages, or brush their teeth for at least 6 hours in order to allow the teeth to absorb the fluoride. Depending on your child’s oral health or the doctor’s recommendation, fluoride treatment may be required every three or six months.
Sealants
Sometimes brushing is not enough, especially when it comes to those hard-to-reach spots in your child’s mouth. It is difficult for a toothbrush to get in between the small cracks and grooves on your child’s teeth. If left alone, those tiny areas can develop tooth decay. Sealants give your child’s teeth extra protection against decay and help prevent cavities.
Dental sealants are a plastic resin that bonds and hardens in the deep grooves on your child’s tooth’s surface. When a tooth is sealed, the tiny grooves become smooth and are less likely to harbor plaque. With sealants, brushing your child's teeth becomes easier and more effective against tooth decay.
Sealants are typically applied to children’s teeth as a preventive measure against tooth decay after the permanent teeth have erupted. It is more common to seal “permanent” teeth rather than “baby” teeth, but every patient has unique needs, and Dr. Wullbrandt will recommend sealants on a case-by-case basis. Placing sealants is a quick, simple, and non-invasive procedure.
Sealants last from three to five years, but it is fairly common to see adults with sealants still intact from their childhood. A dental sealant only provides protection when it is fully intact, so if your child’s sealants come off, let Dr. Wullbrandt know, and schedule an appointment for your child's teeth to be re-sealed.
Mouthguards
Whether your child wears braces or not, protecting his or her smile while playing sports is essential. Mouthguards help protect the teeth and gums from injury. If your child participates in any kind of full-contact sport, the American Dental Association recommends that he or she wear a mouthguard. Choosing the right mouthguard is essential. There are three basic types of mouthguards: the pre-made mouthguard, the “boil-and-bite” fitted mouthguard, and a custom-made mouthguard from the dentist. When you choose a mouthguard, be sure to pick one that is tear-resistant, comfortable and well-fitted for your mouth, easy to keep clean, and does not prevent your child from breathing properly. Dr. Wullbrandt can show your child how to wear a mouthguard properly and how to choose the right mouthguard to protect his or her smile.
Silver Diamine Fluoride
Silver Diamine Fluoride (SDF) is a unique type of fluoride that actually stops active decay when placed on a cavity. It is an FDA-approved topical solution treatment that both treats and prevents dental caries and reduces tooth sensitivity. It is made with two acting ingredients: the silver component is an anti-microbial agent that kills bacteria and prevents the formation of new biofilm, and the fluoride prevents further demineralization (softening) of the tooth structure. Silver Diamine Fluoride can be attractive because it is non-invasive being just brushed on versus a filling or crown where the tooth has to be drilled.
However, treatment with SDF does not eliminate the need for restorative dentistry (fillings, crowns, etc.) to repair function or aesthetics, but is effective at preventing further decay for a period of time. This treatment can be strategic interim treatment when your child is young and unable to cooperate during treatment. One consideration is that silver diamine fluoride does stain the treated area black, thus a more esthetic restoration is often done when your child is older and more able to cooperate during treatment.
How is SDF treatment performed?
- The teeth are brushed without paste and rinsed.
- The carious teeth are isolated, kept dry, and all excess debris is removed.
- A micro brush is dipped in a drop of SDF and placed on the lesion(s) for two minutes.
- Any decayed areas will stain black. A healthy tooth structure will not stain.
- Excess SDF is removed and patients are instructed to not eat or drink for one hour.
Why use SDF?
We recommend using SDF in several situations, including:
- Children who have extreme decay (severe early childhood caries)
- Young children who have difficulty sitting still for treatment
- Special needs patients
- Children with carious lesions (cavities) that need to be treated over several visits
The Advantages of SDF
- Provides immediate relief from tooth hypersensitivity
- Kills the organisms that cause cavities
- Hardens softened dentin making it more acid- and abrasion-resistant
- Does not stain healthy dentin or enamel
Bonding
Bonding is a conservative way to repair slightly chipped, discolored, or crooked teeth. During dental bonding, a white filling is placed onto your child's tooth to improve its appearance. The filling “bonds” with the tooth, and because it comes in a variety of tooth-colored shades, it closely matches the appearance of your child's natural teeth.
Tooth bonding can also be used for fillings instead of amalgam. Many patients prefer bonded fillings because the white color is much less noticeable than silver. Bonding fillings can be used on front or back teeth, depending on the location and extent of tooth decay.
Bonding is less expensive than other cosmetic treatments and can usually be completed in one visit at our office. However, bonding can stain and is easier to break than other restorations. If it does break or chip, please contact our office and let us know. The bonding can generally be easily patched or repaired in one visit.
Crowns
Stainless Steel Crowns
A stainless steel crown is a "cap" cemented onto an existing tooth that fully covers the portion of the tooth above the gum line. In effect, the crown becomes the tooth’s new outer surface. It is a hallmark restoration used by pediatric dentists, usually to treat a baby tooth that has a larger cavity, or to manage extensive decay where many baby teeth are affected. In the case of a baby tooth that has a larger cavity, a crown that covers the whole tooth is much more stable than a large filling in a small tooth. In the case of extensive decay, crowns cover the decayed teeth, thereby removing all decay and not allowing new decay to happen in prone teeth. Stainless steel crowns are considered a good temporary restoration to save a primary tooth until the permanent tooth can erupt and take its place. Keeping the primary tooth if at all possible is very important. A primary tooth can be restored with a stainless steel crown during one appointment. A crowned tooth must be brushed and flossed just like other teeth.
Occasionally stainless steel crowns are needed for children who experience a larger cavity in a permanent molar. This treatment serves as a good interim restoration to protect the tooth until the child is older and can get a more long-term usually porcelain crown.
In esthetic zones of the mouth stainless steel crowns are available that have a resin veneer on the front surface (NuSmiles).
NuSmile - The World's Most Trusted Esthetic Pediatric Crown
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State-of-the-art pre-veneered crowns. Made with the highest quality surgical grade materials, latest-generation proprietary processes, and proven durability since 1991.
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Excellent form and function. Esthetic pediatric crowns that look natural and provide confidence for a child to smile again.
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Pulp Therapy
If your child’s primary tooth has extensive decay or has been damaged by trauma, action may be needed to restore the integrity of the tooth and prevent infection from spreading to surrounding teeth. After a set of X-rays are taken, your dentist will be able to assess the extent of the infection and recommend treatment.
If the decay or trauma is confined to the crown of the tooth, a pulpotomy may be recommended. When a cavity gets really deep, close to the pulp of a tooth, or even into the pulp, the pulpal tissue becomes irritated and inflamed. A pulpotomy is when the inflamed pulp chamber, usually on a baby molar, is removed. The dentist will remove all the infected material in the pulp of the crown only, leaving the living tooth root intact. After a pulpotomy on a baby molar, the empty space will be filled with a pulpal medicament and a stainless steel crown will be placed to restore the tooth.
Root Canals
In the past, if your child had a permanent tooth with a diseased nerve, he or she would probably lose that tooth. Today, with a special dental procedure called “root canal treatment”, your child’s tooth can be saved. When a tooth is cracked or has a deep cavity, bacteria can enter the pulp tissue and germs can cause an infection inside the tooth. If left untreated, an abscess may form. If the infected tissue is not removed, pain and swelling can result. This can not only injure your child’s jawbones, but it is also detrimental to his or her overall health.
Root canal treatment involves one to two visits. During treatment, Dr. Wullbrandt will remove the affected tissue. Next, the interior of the tooth will be cleaned and sealed. Finally, the tooth is filled with a dental composite. If the tooth has extensive decay, Dr. Wullbrandt may suggest placing a crown to strengthen and protect the tooth from breaking. As long as your child continues to care for his or her teeth and gums with regular brushing, flossing, and checkups, the restored tooth can last a lifetime.
Extractions
There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth at risk of decay, so the doctor may recommend its removal. Infection, orthodontic correction, or problems with a wisdom tooth can also require the removal of a tooth.
When it is determined that a tooth needs to be removed, Dr. Wullbrandt may extract the tooth during a regular checkup or may request another visit for this procedure. The root of each tooth is encased within the jawbone in a “tooth socket”, and the tooth is held in that socket by a ligament. In order to extract a tooth, the dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with the doctor any concerns or preferences for sedation.
Space Maintainers
If your child’s tooth has come out too soon because of decay or an accident, it is important to maintain the space to prevent future space loss and dental problems when permanent teeth begin to come in. Without the use of a space maintainer, the teeth that surround the open space can shift, impeding the permanent tooth’s eruption. When that happens, the need for orthodontic treatment may become greater.
Types of Fixed Space Maintainers
Space maintainers utilize orthodontic bands and stainless steel wire to create a design that is fixed (cemented) in the mouth to best preserve space. They can be unilateral (on one side of the mouth), or bilateral (utilizing both sides of the mouth). Space maintainers can seem "big" in a child's mouth initially, but with encouragement and patience they soon hardly notice the "spacer" is there.
A lingual arch is used on the lower teeth and a Nance on the upper teeth when teeth on both sides of a tooth arch are lost. For a lingual arch, a wire is attached to bands on the permanent molars and runs along the tongue side of all the remaining teeth creating an arch shape, thus the reason for its name. For a nance, wires are attached to bands on the permanent molars that lead to an acrylic button that rests on the front part of the hard palate.
In the case of a lost second primary molar prior to the eruption of the first permanent molar, a distal shoe may be recommended. Because the first permanent molar has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum which will guide the permanent molar into its proper position and preserve proper space.
If your child ends up having a spacer, we always check and maintain them at their regular dental visits. When we see the tooth or teeth beginning to come in that the spacer was saving space for, we can then easily remove it.
Wisdom Teeth
Wisdom teeth are types of molars found in the very back of your child’s mouth. These teeth usually appear in late teens or early 20s, but they may become impacted (fail to erupt) due to lack of room in the jaw or angle of entry. When a wisdom tooth is impacted, it may need to be removed. If it is not removed, your child may develop gum tenderness, swelling, or even severe pain. Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections, and even gum disease.
Wisdom teeth are typically removed in the late teens or early twenties because there is a greater chance that the tooth’s roots have not fully formed and the bone surrounding the teeth is less dense. These two factors can make extraction easier as well as shorten the recovery time.
In order to remove a wisdom tooth, Dr. Wullbrant first numbs the area around the tooth with a local anesthetic. Since the impacted tooth may still be under the gums and embedded in the jaw bone, he will need to reflect the gum and possibly remove a portion of the covering bone to extract the tooth. In order to minimize the amount of bone that is removed with the tooth, he will often “section” the wisdom tooth so that each piece can be removed through a small opening in the bone. Once your child’s wisdom teeth have been extracted, the healing process begins. Depending on the degree of difficulty related to the extraction, healing time varies. Dr. Wullbrandt will share with you what to expect and provide instructions for a comfortable, efficient healing process.
