Important Tips for Dental care for Baby

If you have a baby tooth with decay, the usually restorative option is a white filling. If the decay is extensive, a crown may be recommended. There are few options when it comes to crowns for baby teeth. For back baby teeth there really is nothing better than the good ole' stainless steel crowns. They are relatively easy to do and last till the teeth normally fall out. Since they are in the back, cosmetics is not as much of a concern. They are available for the front teeth and work quite well. However, most people don't want "silver" in the front. I don't blame them.

Pedo-Jacket crowns:
So, are white crowns available for front baby teeth? Yes. There are several types each of which has benefits and drawbacks. A porcelain crown like you do on adult teeth is really not an option for those little baby teeth. The teeth simply are way too small. A Stainless steel crown is good, but looks bad. There is a thing called a NuSmile crown (or other variants) that is basically a stainless steel crown with something white coating the front. It is harder to place and looks a little fake (sort of a harsh white) especially if there is just one there. In addition, the white stuff on the front sometimes chips off. Another white option is a "Strip" crown. This is basically a clear form that is filled with white filling material and placed over the tooth. After light curing, the outer clear shell is removed leaving basically a white filling all around the tooth. This option looks the most natural, but is also the most fragile. It can only be used if there is a good bit of tooth structure remaining after decay removal and crown preperation. One option we use a lot is the "Pedo-Jacket" crown. This is basically a white plastic shell you place in a similar manner to the strip crowns. You can either remove the outer shell like a strip crown or leave it on there, which is the usual method. They look good, but sometimes kids chew through the outer shell which causes problems.

So, in summary, there is no magic bullet. All crowns have some kind of drawback. This is very frustrating for us and for parents. Kids are so rough on their teeth. Again, it should be noted is is very unusual to do porcelain crowns for baby teeth. There are many reasons why they are not ideal. The only time I have done them is for older teenagers with congenitally missing back teeth (with the baby tooth still there at that age) whose only cosmetic option is the porcelain fused to metal crown (those run around $800 or more each) and usually necessitates a pulpal treatment as well due to the small tooth size, and these crowns having a questionable prognosis in baby teeth. Also, it should be noted that there is a NuSmile type crown for back baby teeth, but the white tends to get worn off very easily due to the tight occlusion. We hardly ever do those though many parents ask if there is some kind of white option for those back teeth. Well, not really any good option yet. Maybe some day...

The Dental Specialties

Most physicians specialize in some sort of area where they have a particular interest or expertise like cardiovascular surgery, oncology, or as a pediatrician. Most dentists are generalists and do not specialize. They are skilled at most all the areas of dentistry. There are about 15% of dentists that choose to specialize in one of the recognized dental specialties. Now, I have to say there are general dentists who emphasize some area of dentistry that they have chosen to either focus on or promote in their practice, areas like "cosmetic dentistry" or "implant dentistry". That's fine, but the recognized (by the ADA) specialties are: Oral and Maxillofacial Surgery, Orthodontics, Pediatric Dentistry, Endodontics, Periodontics, Prosthodontics, Oral Pathology, Oral Radiology, and Public Health. These have specific educational requirements as defined by the ADA. Also, see my previous post How to Become a Pediatric Dentist. Now, as you may can deduce, getting into a dental residency can be competitive. Generally you need to be in the to 20% of your dental school class. In addition your individual skills, personality, and drive influence which specialty would be the best for you. Most specialty residencies take two or three years after dental school. Here is a brief summary of the specialties:

Oral and Maxillofacial Surgery-These are surgeons of the mouth and face. Mostly they remove wisdom teeth, but do many other things as well. They remove tumors and biopsy lesions. They often do cosmetic reconstruction of the face after trauma like a car accident or for orthodontic cases. This is the fairly glamorous and dramatic kinds of things you see on TV shows. Some of what they do overlaps with plastic surgery and /or other surgeons. They often have an M.D. degree as well as a dental degree. Usually this specialty takes 5 additional years of school and experience after dental school. Most Oral Surgeons I know are "Get-R-Done" kind of folks. They like closure and are typical confident surgeons. One more thing, a doctor with a DDS does not mean he is an oral surgeon. Se my post on DMD or DDS, What's the Difference? to explain that.

Orthodontics-This is the most common specialty with which most people are most familiar. You know, Braces. Most of their time is spent placing and adjusting braces that correct crowding and other defects of the occlusion and face. They even get involved with the orthodontic side of surgical cases. They coordinate with the oral surgeon on these types of cases. Diagnosis is an important part of this specialty, the understanding of growth and development. Most Orthodontists I know are compulsive perfectionists.

Pediatric Dentistry-This is my baby. Just like with Pediatrics, Pediatric Dentistry is an age-defined specialty, not a procedure defined one. We see children form birth to 21 years of age. That usually gets the kids through the time when dental growth ceases and they get their wisdom teeth in (or out). I still have some older patients that don't want to leave when they get older! We do comprehensive treatment of children. That means preventive and restorative treatment. Much of the skills inherent to "Pedo" have to do with behavior management and getting the treatment the children need in the most comfortable and fun way possible. Pediatric Dentists also do braces. You have to be a special type of person to be a Pediatric Dentist. Some of us are goofy and outgoing, some are quiet and gentle, but all of us love children. Many people wonder how we can do it, dealing with children all day long under stressful circumstances. Even other dentists who are skilled at many other things will never get near a child patient. The secret is that the parents often are much harder to deal with than the kids!

Endodontics-This is the specialty of the pulp of the tooth. Root Canals mostly. It takes patience to do this. Cleaning out the canal of the tooth and filling it up. They are really nice people.

Periodontists-Gum doctors. They usually do periodontal surgery of the gingiva. Some also do implants. Where the oral surgeon can do magnificent surgical things, the periodontist is more of a finesse surgeon. They can place on of the most complicated sutures (stitches) I have ever seen.

Prosthodontics-these doctors replace and repair teeth and oral structures. They do crowns, bridges, implants and especially Dentures. Every general dentist does these things too, but the Prosthodontist treats the more complicated cases.

Oral Pathology-Whatever a surgeon removes, the oral pathologist tells you what it is. They work in a laboratory environment and almost never even see the patient. Their decisions and diagnosis, however, are extremely important. They can tell you if the lesion on your lip is benign or if it is cancer. They can also do the "CSI" thing with forensic dentistry. I used to love histology in school. This is the specialty of microscopes and laboratories.

Oral Radiology-X-Rays. Oh the things you'll see. Superman never had the vision skills of these guys. Radiology along with the pathologist can determine what disease process you are dealing with. Magnetic Resonance Imaging (MRI), Digital Computer Enhanced Imaging, etc. are the realm of the radiologist. They are usually are at the dental school in some dark room somewhere.

Public Health Dentistry-These are the unsung heroes of Dentistry. They may have done more for the dental health of the public than anyone. Their job is to prevent the problems the rest of us are spending all our time fixing. They also have to deal with insurance and access to care issues as well. They usually are in academic settings.

All these specialties involve additional schooling beyond the four years of dental school (usually two or three years, or five for oral surgeons). Unlike with physicians, you usually have to pay tuition rather than receive a salary or stipend during these years. General dentists also can receive additional education like General Practice Residencies (GPR's are usually one year) and continuing education. All of us never really finish school, however. The science advances as fast as we learn/forget the old stuff.