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What is a Pulpotomy?

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Our pediatric dentist said my son needs a pulpotomy because his tooth is infected. What is it and why can’t we just take out the tooth if it is a baby tooth anyway?

Mark

Dear Mark,

Boy smiling holding toothbrush

Essentially, a pulpotomy is the child’s version of a root canal treatment. When your son gets his treatment, your pediatric dentist will remove most of the pulp in his tooth. This should be done down to the roots. Then, the tissue inside is daubed with a disinfectant, sealed, then protected with a dental crown. Most children get a stainless steel crown.

You asked an important question as to why you’d need to preserve a baby tooth. In most cases, you don’t. The big exception is when it is a molar. These need to stay in your son’s mouth until he is around twelve years of age. If they come out prematurely, the remaining teeth will shift which leads to crowding as the adult teeth come in. This will cost you a fortune in orthodontics.

There is an alternative if you don’t want to save the tooth. You could have it extracted, but then you would need to place a space maintainer to keep the spot reserved.

Whatever you decide, it will likely make things more comfortable for your son if your dentist uses something like nitrous oxide to put him at ease during the procedure.

What you don’t want to do is put this off and allow this to turn into a dental emergency. Even in the 21st century, people still die from tooth infections. It is much better to get this taken care of as soon as possible.

This blog is brought to you by Auburn, AL Dentist Dr. Raymond Bolt.

Do Adults Need Fluoride?

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I’m a little concerned about the costs of my dental care. I have just started going back to the dentist after years of avoiding it. I have dental insurance now, but my dentist is doing procedures the insurance doesn’t cover. Two things which are making the affordability a challenge is his doing x-rays every six months. My insurance only covers it once a year. The second thing is the fluoride. He’s doing fluoride treatments on me but my insurance is saying that is only for children.

Paul

Dear Paul,

family: Mom, day, daughter, and son with the children on the parent's backs. All smiling

Pediatric and adult teeth need different types of care.

Let’s start with the x-rays. Typically, patients are given bitewing x-rays once a year and panoramic x-rays once every five years. While these are the standard recommendations, there are exceptions.

One exception would be if you are monitoring decay or other dental problems that have cropped up. Some patients are more susceptible to decay than others. It is not always a hygiene or lifestyle issue. Sometimes they’ve just been handed bad dental genetics.

That being said, some dentists just require x-rays at every appointment. If it is a financial hardship for you, I recommend speaking to the dentist about that. A compassionate dentist will want to provide quality care their patients can afford. If they refuse to work with you on the issue, then it is time to switch practices.

Fluoride: Adults versus Children

Fluoride is usually a pediatric dental treatment. It’s not given to adults because once the teeth are fully formed, the benefits to the enamel are not that useful.

Another reason it is not generally given to adults is because they often have porcelain work in their mouths, such as dental crowns. Most dental offices use acidulated fluoride which will etch the porcelain crowns and cause them to pick up stains.

There are exceptions as with anything else. If an adult is undergoing a treatment which can damage their teeth, such as radiation or chemotherapy, fluoride will help prevent decay.

This blog is brought to you by Auburn, AL Family Dentist Dr. Raymond Bolt.

Baby’s Front Teeth Haven’t Erupted

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I’m a little worried because my daughter’s two front teeth haven’t come in yet. She’s almost ten months old. The weird thing is the teeth that would be next to them have come in, so she looks like a baby vampire. Is this okay or is something wrong?

Nervous Mama

Dear Nervous Mama,

Chart of children's teeth with their names

Take a deep breath. There’s no need to grab some garlic yet. While there is a general schedule, teeth don’t always follow that schedule. It is not unheard of for the lateral incisors to erupt before their central incisors do.

Here’s a loose schedule of when teeth come in:

Lower Central Incisors – 6 to 10 months

Upper Central incisors – 8 to 12 months

Lower Lateral Incisors – 10 to 16 months

Upper Lateral Incisors – 9 to 13 months

Lower Cuspid (Canine) – 17 to 23 months

Upper Cuspid (Canine) – 16 to 22 months

Lower First Molar – 14 to 18 months

Upper First Molar – 13 to 19 months

Lower Second Molar – 23 to 31 months

Upper Second Molar – 25 to 33 months

When Should I Child First See a Pediatric Dentist?

It’s recommended you first take your child to the pediatric dentist or a general dentist who treats children when their teeth first start erupting. This is usually a simple appointment where the child is just introduced to the dentist and staff and shown what the different tools are. Its intention is to allow the child to get familiar with the dentist in a non-threatening environment. In your sweet babe’s case, they will likely do an x-ray as well just to see if the central incisors are actually there.

Sometimes, a person will have congenitally missing teeth. This is okay too and there are many solutions. Either way, your child will not go toothless throughout their life. Even if they are missing both baby and adult teeth there are fantastic tooth replacement options these days.

This blog is brought to you by Auburn Dentist Dr. Raymond Bolt.

How Often are Pediatric Dental X-Rays Necessary?

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I’m very faithful at taking my children to the pediatric dentist. The problem I’m running into is I have three children and our pediatric dentist insists on doing x-rays at every appointment. First, I worry about that amount of radiation. Second, our dental insurance only covers it once a year. Is it really necessary to do it both times? I can’t always afford the cost. Can I request to just do it once a year?

Laurie

Dear Laurie,

four children smiling

We’ll cover the insurance issue first. Dental insurance companies do not look out for the best interest of the patient. They are more interested in paying for what is adequate rather than what is best. So, while getting x-rays once a year is the standard in some offices, it really depends on the child. Even pediatric dentists who generally prefer doing x-rays once a year will have some patients where they require them twice.

Why Require Extra X-Rays at the Pediatric Dentist

There are two general reasons why a pediatric dentist would require x-rays at every appointment. The first is if the family or child has a genetic predisposition to decay. In that case, it is much safer to do x-rays more often than to risk decay sneaking up. It is better for the child, the tooth, and your budget to catch it early and do a small filling than to have it grow unseen and then require a dental crown.

Another reason would be if you have some decay the dentist is just watching. They are trying to make sure it doesn’t start growing toward the pulp requiring a pulpotomy.

Radiation and Dental X-Rays

One thing which should make you feel a bit better is dentists use digital x-rays. These carry far less radiation than traditional film x-rays. It exposes your children to no more radiation than if they stood outside in the sun for a few moments.

Dealing with the Cost of Multiple X-Rays

If your children aren’t in one of the two categories mentioned above, which justifies requiring x-rays at each appointment, then you can request to have them only once a year. If they say no even after you explain your financial situation, it may be time to switch to a more affordable dentist who understands budget constraints.

This blog is brought to you by Auburn Family Dentist Dr. Raymond Bolt.

Silver Crowns in Children

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I have a classroom full of children with silver on their back teeth. Most of them look like crowns and some could be fillings. Why would so many children need crowns? And why do they all seem to be silver?

Andrea

Dear Andrea,

children smiling
Healthy Smiles Make Happy Children

It’s obvious you’re a caring teacher and want to understand more about your student’s health. When it comes to why your children have so many restorations, there can be a variety of factors:

  • Genetics plays a huge part. Some patients do everything right and still have decay. They just lost the genetic lottery when it came to teeth.
  • Another factor is socioeconomic. If they didn’t have dental insurance for their children they may only take them when there’s a problem.
  • Lack of sealings: If parents don’t regularly take their children to the dentist, they may not be aware of dental sealings which protect children from getting decay on their molars.

Silver Crowns for Pediatric Patients

There are usually two very good reasons to give children silver crowns instead of a traditional porcelian-fused-to-metal crowns or an all-porcelain crowns.

They are pre-fabricated in set sizes. This means the pediatric dentist can place them in just one appointment. This makes the appointment much easier for the patients.

Often, children need some form of dental sedation to get through more complicated appointments. This way they only need one appointment.

That makes it easier on the parents, both for interruptions to their lives with scheduling and cutting down on costs for a second appointment.

Probably the best way you can help your students is to have a pediatric dentist come visit your class and teach the children about the proper way to brush and floss. Then, keep up with things like free clinic days and dental sealing days and let the parents know about them.

This blog is brought to you by Auburn, Al Dentist Dr. Raymond Bolt.

Pediatric Dentist Blames My Son for Fillings Coming Out

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I don’t know what’s going on. My son needed a filling. I told my dentist I wanted him to have a white filling. He said children can’t get white fillings. I told him that’s all my nephews have and he relented. The filling fell out two weeks later and all he said is, “I told you children can’t have white fillings and you wouldn’t listen.” So, is he right? If so, how do my nephews have them?

Anna B.

Dear Anna,

Boy smiling holding toothbrush

Here’s the situation. The bonding procedure for the amalgam (silver) fillings is completely different from the procedure for the composite (white) fillings. If he doesn’t place many composite fillings he’s likely not as skilled in getting them secure.

The only real problem in placing them on children is the fact that they have to remain completely dry during the bonding procedure. Children are naturally wiggly and their tongues can get in the way. If any moisture sneaks in it will break the bond.

That doesn’t mean that your son has to get the amalgam fillings. He just needs to see a dentist who is skilled at placing them and also treats children. In all honesty, that’s not nearly as hard as it sounds.

The first thing I’d look for is a mercury-free dentist. These dentists only place white composite fillings and are therefore skilled in the procedure to place them. Then, you just need to know if they treat children.

Must Children See a Pediatric Dentist?

General Dentists are qualified to treat children, so your son doesn’t have to see a pediatric dentist. They’ve all done a pediatric rotation. However, if you want your son to have a good experience, you need to be certain the dentist actually enjoys treating children.

One way to do that is to ask what age they first like to see them. If they say around 8 or 9 years old they don’t really enjoy children. However, if they say 2 or 3 then you can be sure they like taking care of children.

Though, do check their reviews. It’s important children have positive experiences with the dentist. Most people who avoid the dentist as an adult, do so because of traumatic experiences in their childhood. If they love the dentist while their children, they’re much more likely to keep going in adulthood.

This blog is brought to you by Auburn Dentist Dr. Raymond Bolt.

Children and Dental Anxiety

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My son has always gone to my dental office and done fine. He’s only just needed cleanings and they’re pretty easy. This last appointment, however, the dentist told him he had a cavity and needed a filling. He was going to do it right then but my son freaked out when he pulled out the needle. I was taken completely by surprise because he’s 9 and I thought he’d be more mature than that. He seems to be afraid of the shot. The dentist just let it go and didn’t work on his cavity. Is there a way to help a child with dental anxiety?

Catherine.

Dear Catherine,

Boy smiling holding toothbrush

Helping Children with Dental Anxietiy takes an Understanding Dentist

It sounds like your dentist is not that experienced with children. I don’t know any pediatric dentist who’d just pull out a needle without preparing a child ahead of time. It’s not uncommon for children to be afraid of the dentist when it comes to shots and cavities.

See if your dentist offers some type of dental sedation. I’d start with the lowest form of sedation which is nitrous oxide. It’s sometimes called laughing gas. It’s just a nose piece that will be placed on him and allow him to breathe in the gas. It will relax him. Most children just fall asleep. Then once the procedure is done, they simply turn up the oxygen and he’s good to go.

Pediatric or General Dentist

He doesn’t necessarily have to see a pediatric specialist. There are plenty of general dentists who enjoy treating children and are good at working with them. If you’re happy with your current dentist, that’s fine. But, if he has trouble relating to children, it may be in your son’s best interest to switch.

General dentists do learn about pediatric dental care and are qualified to treat children. If there was ever an issue which came up requiring a specialist they can just give you a referral.

Don’t put off getting his cavity filled. These things can blow up on him quickly and turn into a tooth infection. Then you’ll need an emergency dental appointment. That will only add to his anxiety.

This blog is brought to you by Auburn, AL Family Dentist Dr. Raymond Bolt.

Pediatric Dentist Hates Questions

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Help me. My son’s pediatric dentist hates questions. I tend to want to ask a lot of them because I want to know what’s happening. The last time he said, “If you have trouble trusting your dentist maybe you should get a dental degree so you won’t have to ask so many.” I was offended, but he’s the only pediatric dentist within 20 minutes. Now he’s talking about my son needing a pulpotomy and I have no idea what that is. Can you help me? It sounds scary.

LeeAnne

Dear LeeAnne,

A little girl smiling in a pediatric dental chair

While it does sound scary, it really isn’t. Before we get to the pulpotomy, though, I want you to understand that your current pediatric dentist is way out of line. His job is to explain what’s being done thoroughly along with all your options so you can give informed consent. You’re not getting that. I really think you need a new pediatric dentist. You may not have to drive as far as you think. There are many general dentists who treat children. Many families find it convenient for them to all go to the same clinic.

Now, onto your question. A pulpotomy is simply a child’s version of a root canal treatment. It probably won’t seem any different to him than getting a filling. Most of the time if the parent doesn’t act afraid the child won’t be either.

This procedure isn’t always necessary though, so I want to make sure he’s not getting one he doesn’t really need. I’m a big believer in only doing necessary work on children especially. If it’s a baby tooth that’s likely to fall out very soon, I wouldn’t bother. If it’s not looking like it’s about to come out you could just deal with the decay and get him a mercury-free filling. If the decay is so large you’re worried about an infection developing, it’s probably better to just extract the tooth.

The exception to the above being if it’s a molar. These have to stay in until he’s around 11 or 12 years old. If it comes out prematurely, your looking at crowding teeth and expensive orthodontics. A pulpotomy will help keep the molar in its rightful place until it’s time to go.

If it turns out the tooth can’t be saved and he needs an extraction, don’t panic. Your dentist can put a space maintainer there to hold the place for his twelve-year-old molars.

I hope this puts your mind at rest. Now go out there and find a better dentist for your little guy (and you – questions are important)!

This blog is brought to you by Dr. Raymond Bolt.

Pediatric Dentist Missed Massive Cavity

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I’m not sure how this could have happened. My son was just into the dentist’s office a couple of months ago. They did x-rays, a cleaning, and a checkup then gave him the all clear. I thought everything was fine, but a few days ago he woke up crying about a tooth hurting. I called his pediatric office, but they only work four day weeks. I wasn’t sure what to do. He was in so much pain. I ended up calling my dentist and asking if they would be willing to have a look at him. They were, thankfully. I brought him in. When they did an x-ray, they noticed he had a massive infection. My dentist said there is no way that wasn’t there at his last appointment. It was so bad they had to take his tooth. It was a molar, which worries me. I think I heard they’re important for children to keep. I was grateful my dentist was good with my son, so the appointment wasn’t too horrible for him. They gave him some medicine to make him sleepy and relaxed before the removed the tooth. I don’t know what I’d have done without them. Is it normal for a dentist to miss something this big? Should I say something?

Patsy

Dear Patsy,

A little girl smiling in a pediatric dental chair

No, your pediatric dentist shouldn’t have missed that. While some infections can blow up quickly, it sounds like that one was there for a while. I’m glad you were proactive in calling your office. Something else which bothers me is the lack of emergency protocols at your pediatric dentist’s office. It’s fine if they want a four day work week, but they should have something in place in the case of patient emergencies. The fact that they don’t, makes me wonder how much they truly care about their patients.

I would certainly bring it up with them. Not only did their negligence cost your son a tooth, it could have been much worse if the infection spread to his brain or heart, both of which are quite close to his jaw.

Your intuition about his molar is right. While some baby teeth can fall out early with no consequences, the same is not true about molars. They need to stay until your son is about twelve years old. The simple solution is to have a space maintainer placed where his molar was. That will keep his teeth from shifting, causing crowding later. If your office hasn’t done so already, ask them to place one.

You Don’t Have to Go to a Pediatric Clinic

It doesn’t sound like you’re being well-served by your current pediatric. In your place, I’d look for another one. If you live in an area where there is only one pediatric clinic, it’s perfectly acceptable to go to a general dentist who enjoys treating children and do a fantastic job in relating to them. I suppose you’ve seen that with your dental clinic when they stepped in to help you.

You may even want to just let your son start visiting your clinic, if it’s okay with them. Your son seemed to respond well to them and they seem quite attentive. The important things are your son gets the care he needs and he has positive experiences with his dentist. This way he gets a lifetime of care without anxiety.

This blog is brought to you by Dr. Raymond Bolt.

Flipper for a 2 Year Old?

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My two-year-old daughter fell and lost a tooth. I went to see our dentist to get her a dental flipper and he told me I was nuts. Toddlers don’t get flippers. I’m worried her teeth will shift. What do I do? Will another pediatric dentist make one?

Sara

Dear Sara,

A little girl smiling in a pediatric dental chair

I understand why you’re concerned, but I want to put your mind at ease. A child’s first teeth won’t cause the shifting that you’re worried about. It’s the back molars that cause the shifting problems. If one of those ever had to be permanently removed, a space maintainer can be placed there to keep everything in its proper location.

I’m sorry your dentist was rude to you. In fact, he’d have been much more useful if he would have explained the reasoning behind his words. I wonder if you’d be better served with a different dentist.

A dental flipper won’t work for a toddler. For one, its removable nature makes it a choking hazard. Plus, her jaw is developing rapidly so it will never stay attached.

What to Look for in a Pediatric Dentist

As I mentioned earlier, you probably should go to a different dentist for your daughter. If he’s that impatient with you, imagine the experience a toddler would have when he gets frustrated with her. You want her experiences with the dentist to be positive.

If you like going to the same clinic together, there are general dentists who love working with children. You could look for one of those. Just make sure the first time they want to see children is when they’re young. If they say not to come until they’re eight or nine years old, that is an indication they don’t really enjoy working with children.

You also want someone who will be patient and explain every aspect of treatment with you along with all alternatives.

It sounds like you’re a very conscientious mom when it comes to her oral care. One of the problems we often run into with pediatric patients is parents don’t bring them in for checkups when they’re young, thinking they won’t need the care. Unfortunately, that usually means the first time they have an appointment is when they have a dental emergency. This makes their first experience with the dentist a negative and sometimes painful one. That’s what they’ll associate with the dentist the rest of their lives.

I don’t think you’ll make that same mistake because you’re already thinking about things and seem very proactive.

This blog is brought to you by Dr. Raymond Bolt.