Your Child's First Visit
- It is important that a parent or caregiver is with a child for their first visit so that we can discuss any findings with you.
- Please complete the medical history form and pre-appointment questionnaire. Referral documents and any radiographs should also be brought.
- The appointment will begin with an interview to discuss your child's concerns and needs.
- Your child will then be examined in either our consulting room or in a dental chair.
- Where possible, your child's first visit will include a thorough dental examination, radiographs (x-rays) may also be taken.
- While examining your child's teeth we ask that you observe passively, children are easily distracted and will respond to a parent's voice.
Subsequent visits will then be arranged for complete dental treatment, including oral hygiene and risk assessment for the prevention of future dental disease.
Unless a patient has received trauma or is experiencing symptoms no treatment will be conducted at the first visit.
Treatment will either be performed in our rooms or at Lingard Private Hospital.
Treatment is timed and staged to suit each individual patients under negotiation with the patient and family. Estimates for treatment will be given prior to the appointment where possible.
The CDBS is a new Commonwealth Government dental scheme commencing on 1 January 2014 and providing up to a maximum of a $1,000 benefit entitlement for dentistry, generally over two consecutive calendar years.
At the conclusion of this two-year period, providing the recipient remains eligible, a further $1000 benefit entitlement is expected to apply. Nationally, up to 3.4 million children aged from 2 to 17 years may be eligible to access a limited range of essential basic dental services under this means-tested scheme. Eligibility is determined solely by Medicare, not by the dentist.
When a child is proven eligible at any time during the year, that child will be deemed eligible for that whole calendar year.
General anaesthesia is used in paediatric dentistry to allow treatment without causing undue distress or discomfort for the patient.
During a general anaesthetic a patient is maintained in a state of controlled unconsciousness. This is done using medications administered by an anaesthetist. Medications may be administered as a gas, breathed by the patient or through a small cannula. The anaesthetist ensures comfort and safety by continuously monitoring the patient. Modern anaesthesia in Australia is considered to be safe due to the high standard of education and training as well as access to modern medications and equipment.
When are general anaesthetics used?
A general anaesthetic may be recommended based on your child's age, medical conditions, anxiety and complexity of work required.
Will I be with my child?
Parents have an important role in the care of their children as they go to sleep and wake up. Your anaesthetist will explain this. You must remain at the hospital during your child's stay and organise care for other children.
How long will it take?
Most general anaesthetics for dental treatment are performed as day surgery and your child will go home that day.
What about afterwards
Your child will need close supervision during the following 24 hours and outdoor activities such as bike riding, swimming or trampolining should be avoided. Where possible indoor activities such as stories and quiet play should be encouraged.
Some pain and bleeding should be expected depending on your child's treatment and the dentist will discuss this with you.
What to wear?
Unlike adults most children will want to stay in their own clothes.
Dress your child in soft comfortable clothes, what they would wear for a nap. Hospitals may be cold so bring a warm jumper of top for your child. Avoid all-in-ones, metal zips and fasteners and tight fitting clothing.
Where does treatment occur?
Most treatment under general anaesthesia is performed at Lingard Private Hospital in Merewether
Nitrous Oxide Sedation
Nitrous oxide sedation, also called Relative Analgesia (RA), happy gas or laughing gas, is a form of conscious sedation where your child remains awake throughout their dental treatment. The aim of this technique is to make treatment more comfortable, decrease anxiety and provide a state of relaxation. This technique is often used in young children who are able to tolerate a nasal hood (mask).
Please ensure that you do not bring any other children to the sedation appointment, as your child will require your full attention.
Children easily perceive anxiety in others, especially anxious parents! Please assist us by reassuring your child before and after their procedure. Do NOT use words with negative associations such as needle, pain, or injection. The dentist will explain the procedures to your child, step by step, on the day of appointment.
Numbness of the mouth, especially of the lower lip, can be an unusual experience for children. Please remind your child not to bite or pinch the numb lip (or tongue). In the event that your child does bite their lip or tongue, an ulcer will develop. This should heal, on its own in 7-10 days. Drinking a cold drink through a straw can have a soothing effect on a numb mouth.
Your child may have a light breakfast or meal before the appointment. Where possible nitrous oxide sedation appointments are carried out in the morning, as children are more receptive, which makes them more compliant.
Please give your child a dose of paracetamol (panadol) 30 minutes prior to their appointment.
Parents/Guardians are usually allowed in the room during treatment. However, we ask you to remain quiet and not to participate in the procedure. The voice of a parent is very familiar to a child so children divert their attention away from instructions given by the dentist. From time to time the dentist may invite you to 'help' but if this is not done, please assist us by adopting a passive role during the appointment.
Ensure that your mobile phone is set to silent or switched off as noises distract patients under sedation.
If your child is having difficulty with treatment, you may be asked to take a seat in the reception area. This approach often helps children regain their composure. Although every effort is made to provide treatment under RA, this technique is not successful 100% of the time. Your child may require a different approach should they be unable to cooperate throughout the appointment.
Side effects of nitrous oxide may include, nausea, feeling unwell, not being able to cope with the nasal mask (claustrophobic), tingling of the hands/limbs and in some rare cases vomiting (hence the need to only have a light meal).Should you have any questions about the procedure or when you get home please do not hesitate to contact your dentist's office.
Healthy Snacks / Healthy Teeth
Dental decay has been linked to sweet and acid foods. Plaque bacteria in the mouth change sweet food into acid, which causes tooth decay. It is very important to reduce the number of times per day that decay producing food or drink is taken. Children at high risk for decay need to have gaps between meals, so they only eat five times a day. This reduces the amount of acid in the mouth. Drinks of water and milk are welcome between meals because they reduce acid on the teeth.
Tooth-damaging foods and drinks are: sweetened drinks such as juice, cordial, Milo, Quik, Ribena, sports drinks, soft drinks (including sugar-free drinks), and sweet foods including dried fruit, fruit fingers, honey, jam, Nutella or muesli bars. Having these between meals or at school causes cavities. Children will remain at high risk if their diet is not modified.
Frequent consumption of fruit between meals can damage tooth enamel, as fruit can be acidic. When children eat fruit between meals, it is advisable that they follow up with a small square of cheese or a drink of milk or water, as this washes out the acidity from the mouth. Going to bed with an apple in the mouth is not safe.
Tooth-friendly snacks are rice cakes, dry biscuits, popcorn, nuts, cheese slices, peanut butter, vegemite, butter, cut-up vegetables with dips such as tzatziki or hummus. For a healthy, balanced diet, children need three pieces of fruit and five vegetables a day, as well as a high intake of grains and protein, and three intakes of dairy products.
Teeth should be brushed after breakfast and before going to bed at night. Children should clean their teeth with toothbrush and toothpaste (a pea-size ball of low fluoride toothpaste for children under 7 years of age), and then have nothing to eat or drink other than water before bedtime.
- Rather than having lollies in the house, buy a treat for your child once a week (like a plain chocolate Fredo Frog, an icy-pole or an ice-cream that is not sticky and it goes through the mouth quickly). Jelly snakes, Chuppa-chups or Minties are bad because they stay in the mouth for a long time and they are sticky. Have this at the end of a meal, not between meals.
- Do grocery shopping without the children and think savoury, vegetable - crunchy, not sweet.
- At parties, children should eat all the lollies at once. If unable to brush immediately, chewing sugar free gum for 10 minutes is a good alternative. This type of gum stimulates saliva flow that washes out the mouth.
- If making lolly bags for parties, include sugar free chewing gum and non-sticky things.
- Remember that it is the number of times that the teeth are exposed to sweet, sticky and acid things that is important, not the amount eaten.
Space maintainer appliances
Space maintainers have a long history in paediatric dentistry across the globe. The aim of their use is to minimize or prevent the loss of arch length due to the premature loss of a deciduous (baby) tooth. They may be in the form of a band with a loop or two bands and a wire in the palate (roof of mouth) or along the inner aspect of the lower teeth (lingual arch). Their aim is to remain passively in place until the eruption of the permanent teeth.
Considerations for the use of space maintainers
Premature loss of a baby tooth generally results in the loss of space for the adult teeth. This space loss may cause crowding and impaction of the adult teeth, requiring orthodontic correction or extraction of adult teeth.
Construction and placement of space maintainers
Band and loop space maintainers are constructed using a pre-formed band, selected to fit the tooth and a wire loop, which is customized to the space. Full-arch appliances require laboratory construction and require moulds/models of the mouth. Space maintainers are cemented to the teeth using orthodontic cements that are easily removed when the adult teeth start to erupt.
Cleaning, care and maintenance of space maintainers
- Space maintainers are cemented to the teeth but may become de-bonded particularly with hard or sticky food (muesli bars, toffees, sticky lollies)
- Teeth with space maintainers still need thorough brushing and flossing to maintain their health
- Teeth should have radiographs (x-rays) at least every two years to monitor the developing adult tooth
Stainless Steel Crowns
Stainless steel crowns
Stainless steel crowns (SSC) have a long history in paediatric dentistry across the globe. Crowns are prefabricated with multiple sizes and shapes available for molar teeth. They are an extremely durable and as such are an invaluable material for paediatric dentists.
Indications for stainless steel crowns
- Teeth with large carious lesions (holes)
- Teeth that have had pulp therapy
- Where the quality of the remaining tooth structure is poor (hypomineralized) - (Including adult teeth that will need porcelain crowns once a child has stopped growing)
- Teeth with excessive wear (due to erosion or grinding habits)
- Children who require general anaesthesia for dental care
- Children with a high decay rate
(Australasian Academy for Paediatric Dentistry Guidelines)
Placement of stainless steel crowns
Stainless steel crowns are cemented to the teeth using dental cements. This is often done using local anaesthetic or as a part of treatment under general anaesthesia. Crowns go over the remaining tooth and restorative material inside the tooth. Deciduous (baby) teeth with stainless steel crowns are lost (fall out) normally with the crown coming out as a part of the tooth.
Cleaning, care and maintenance of stainless steel crowns
- Stainless steel crowns are cemented to the teeth but may become de-bonded particularly with hard or sticky food (muesli bars, confectionary)
- Teeth treated with a stainless steel crown still need thorough brushing and flossing to maintain their health
- Teeth should have radiographs (x-rays) at least every two years to monitor the underlying tooth.