Bennett Family Dentistry
Michael Bennett, DDS
Ashley Blattner, DDS
Ross Bennett, DDS
Blake Essner, DDS
Cape Girardeau Family Dentist Dr. Bennett
Our Family Caring For Your Family
(573) 334-8013
1200 N. Cape Rock Drive
Cape Girardeau, MO 63701
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pediatrics info

First Visit

This visit mainly will involve counseling on oral hygiene, habits, and on the effects that diet can have on his/her teeth. We like to see younger patient's by the time they reach three years of age.

Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits.

The ADA also recommends a dental check-up at least twice a year; however some children that may be at a higher-than-average caries risk may need to be seen more often.

Gaps between childs teeth

It is normal and even 'ideal' for baby teeth to have spacing between each other. Keep in mind that when permanent teeth erupt, their size will be considerably larger than that of baby teeth. As the baby teeth are lost, the erupting permanent tooth will quickly take advantage of this excess space. Children who do not have spacing in their primary dentition can have a higher incidence of crowding (crooked teeth) in the permanent dentition.

Toothpaste for my child

There is no such thing as the best toothpaste. We recommend ONLY products that have been ADA (American Dental Association) accepted or approved.The selection is usually made on a case-by-case basis, however the main consideration when selecting toothpaste is your child's age.This is due to the risk of fluorosis in younger children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

Enamel Fluorosis

In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.

Silver Caps for children

Recent controversy regarding the use of Stainless Steel Crowns (SSCs) in some states have led some parents to question dental care providers more thoroughly on their use and on other alternatives. SSCs have been used in dentistry for over 50 years for primary and permanent dentition. For primary teeth, SSCs are usually placed on teeth that have extensive caries (where two or more surfaces are extensively involved), or teeth that have pulp treatment (such as pulpotomy or pulpectomy). We also use them in teeth that will remain in the mouth for a considerably long period of time; where other materials will not last long enough. SSCs become loose and come out of the mouth just like normal primary teeth. They work just like normal teeth do, and require the same care. Alternatives to Stainless Steel Crowns do exist, particularly for front teeth.

Usually these can be one of the following:

- A prefabricated SSC that has a white facing bonded to it on the front (Commonly we use the Nu-Smile brand: www.nusmilecrowns.com)

- A white cap fabricated with a white filling material (Usually we call these strip crowns).

- A normal SSC that we modify by building a window in the front of it, which we later fill with a white filling material.

Having baby-teeth pulled

How is that going to affect him or her? Children require extraction of one or more primary teeth in certain situations. These situations may include extensive decay on their front teeth, and/or localized infection (for example an abscess or a gum boil). Extractions are also necessary in cases of trauma, where the baby teeth have been pushed back, pushed forward, broken, or simply knocked out. Parents are obviously concerned of the aesthetic and functional effects (on speech, feeding, and breathing) of removing one or more front baby teeth. There is good evidence that has shown NO long-term speech impediments on these cases. We also know from our professional experience that once the gums heal, children will be able to eat almost anything, since they can still bite-and-cut with the remaining teeth. As far as aesthetics is concerned, your pediatric dentist can offer you information on fixed appliances that can replace the missing tooth/teeth, assuming your child meets the right criteria.

Children continually get new teeth from age 3 months to the age 6 years. Most children have a full set of twenty (20) primary teeth by the time they are 3 years old. As a child nears the age 6, the jaw grows making room for the permanent teeth. At the same time, the roots of the baby teeth begin to be resorbed by the tissues around them and the permanent teeth under them begin to erupt.
Primary teeth are just as important as permanent teeth for chewing, speaking and appearance. They also serve as placement holders for the permanent teeth. Primary teeth also provide structure to help shape the child's face.

Baby Bottle Tooth Decay

Baby bottle tooth decay or syndrome is a form of tooth decay that can destroy the teeth of an infant. This decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. The teeth most likely to be damaged are the upper teeth.

Baby bottle decay is caused by frequent and long exposure of a child's teeth to liquids containing sugar such as milk, formula, fruit juices, pop and other sweetened liquids. These liquids fuel the bacteria in a child's mouth, which produces acids that attack enamel.

Thumb Sucking

It is completely normal and healthy for your baby or young child to suck on a thumb, finger, or pacifier. Children usually give up sucking habits on their own by the time they are 4 to 5 years old.If they stop the habit at this age, the shape of the jaw is usually not affected and the teeth grow in normally. Children who continue sucking on a pacifier, finger, or thumb when their permanent adult teeth start to come in are more likely to have bite problems.

Sucking can cause:
- The top front teeth to slant out
- The bottom front teeth to tilt in
- The upper and lower jaws to be misaligned
- The roof of the mouth to be narrowed
- The need for braces

Treatment:
Your doctor may decide to construct an appliance to discourage thumb sucking.

Now known as "Early Childhood Caries" is an aggressive form of caries that occurs in infants and very young children. It is typically associated with prolonged consumption of liquids containing sugar, and affects initially the top front teeth, later spreading to other "baby teeth". Because of the aggressive nature of this disease, early intervention is necessary.

The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that ALL children should see a dentist before age one.

Baby Tooth Care

Healthy teeth are important to your baby's overall health. Teeth help your baby chew food and form words and sounds when speaking. They also affect the way your baby's jaw grows.

Every baby is different. Generally, the 2 front teeth start to appear between 4 and 7 months of age. Teething is usually painless, but it can make some babies uncomfortable and fussy. Giving your baby a cold teething ring or a cold washcloth to chew or suck on may help. Teething does not cause a fever. If your baby has a fever, you should talk to your doctor.

Start cleaning your baby's teeth twice a day as soon as the first tooth appears. Until your child is 1 year old, you can use a wet wash cloth or gauze to clean your baby's teeth and gums. At about a 1 year to 18 months of age, you should start using a soft baby toothbrush and a small dab of toothpaste that does not have fluoride in it. This type of toothpaste is safe for your baby to swallow.

Be sure to take your baby to a dentist by his or her first birthday, especially if there is a high risk for cavities or any other problems with his or her teeth. It is better for your child to meet the dentist and see the office before he or she has a tooth problem.

Canker Sores

Canker sores are common in adults and children and generally tend to cause discomfort, particularly during eating. Although several factors have been named as possible "causes" of aphthous ulcers, trauma is the most common trigger for them. It has also been observed that they appear in patients who are under stress, or those experiencing health problems. They have also been attributed to hormonal changes, and to some types of dietary deficiencies (i.e., Vitamin B12, Iron, Folic Acid, etc.). Although there is no specific treatment for the ulcer itself, except for severe cases (where usually steroids are prescribed); treatment is usually focused on the pain caused by the ulceration.

Cold Sores

Recurrent Herpes labialis (the common dental term) is a very common viral infection in children and adults. It is caused in most cases by a sub-type of the Herpes Virus, and in most patients it is preceded by an illness (a cold), exposure to sun or exposure to cold. Most patients experience what is known as "prodromic" symptoms such as itching or burning sensation in the area where the blisters soon appear. This information may allow your dentist to recommend therapies that may minimize or eliminate the appearance of the blisters. This infection is usually self limiting and can last up to 14 days before the scabs fall off.

Ankylosis

This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.

Open Bite and Cross Bite

These are two common problems in children that have their origin in discrepancies between the size of the jaws (top and bottom), or discrepancies between the size of the teeth and the amount of space available.

1. A posterior cross bite can appear at an early age, and depending on its cause (malpositioned teeth or misaligned jaws) treatment may be warranted early. It can involve one or both sides of the molar area and in some cases in can cause a 'shift' of the bite. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating a posterior cross bite.

2. Anterior open bites refer to a condition in which the top and bottom front teeth are not in contact (they do not touch each other when the patient bites). The origins of open bites can be traced to habits that patients have or had in the past, and occasionally to discrepancies between the sizes of the jaws. Since most open bites in children are associated to an existing habit, treatment usually addresses the habit itself and is most effective when done at an early age. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating an open bite in children.

Mesiodens

Mesiodens is the most common type of 'supernumerary' (extra) tooth. It is typically discovered on routine radiographs taken in young children (3-6 years of age) and is always located in the mid-line between the upper permanent central incisors. The most common complications of all supernumerary teeth (including mesiodens) is delayed or lack of eruption of the adjacent permanent teeth. Only about 25% of mesiodens erupt spontaneously, therefore most of them require surgical management. Treatment of mesiodens is deferred until permanent incisors have at least 2/3 of root development (between ages 7-9), since early treatment can cause damage to the unerupted permanent incisors.

Missing Permanent Teeth

Hypodontia (the common dental term) describes a situation when fewer than 6 permanent teeth are missing, the term Oligodontia is used when more than 6 permanent teeth are missing (they were never formed). The most common missing teeth are the third molars (otherwise known as the Wisdom Teeth), followed by the premolars and the lateral incisors. Although it is not uncommon to have one missing tooth, patients with multiple missing teeth generally have a strong genetic component and it has been linked to conditions such as Ectodermal Dysplasia and several syndromes. Because early recognition aids in proper treatment, your dentist will refer you to specialists (orthodontist, oral surgeons, etc) that will determine which options suit you best to replace the missing teeth.

Mucocele

This is a common benign lesion in children and adolescents that results from the rupture of the excretory ducts (very small tubes) that deliver saliva to the top tissues of the lips. More than 75% of mucocele are located on the lower lip and their size and color may vary, however, they tend to be relatively painless for the most part. Most of the time, patients report that these "bumps" grow until they burst spontaneously, leaving small ulcers that heal within a few days. This does not mean the lesion is gone, as they often tend to re-appear weeks or months later. Most dentists will recommend surgical treatment for these lesions.

Ranula

This is a relatively uncommon benign cyst in children and adolescents that appears in the floor of the mouth as a result of blockage of the salivary duct located under the tongue. Just like other mucous retention cysts (formed by pooled saliva), Ranulas tend to be relatively painless; however most of them will require surgical treatment. Your dentist will refer you to an oral surgeon for evaluation and treatment.

Traumatic Ulcer

It is not uncommon for children to inadvertently 'bite' on their lips or cheeks, particularly following a dental visit where local anesthetic was used. The main reason why this occurs is the natural curiosity that a child has about the area of the mouth that is 'numb'. We try our best to explain to children that local anesthesia is temporary and we give them (and their parents) instructions on how to prevent 'lip biting'. In the event that this occurs, please notify our office so we can determine if your son/daughter will require treatment (ie, antibiotics or pain medicine).

What is oral sedation?

A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. Our academy (AAPD) has clearly defined the indications for this procedure, and they are as follows:


  1. A) Preschool children who cannot understand or cooperate for definitive treatment.
  2. B) Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
  3. C) Patients requiring dental treatment who cannot cooperate due to a cognitive, physical or medical disability.
  4. D) Patients who require dental care but are fearful, anxious and cannot cooperate for treatment.

As with any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed, and this may limit the extent of work that we can provide. Sedation dentistry is also an option in cases of accidents or trauma, but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred. If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.

What is a General Anesthesia appointment and how safe is it?

The use of general anesthesia for dental work in children is sometimes necessary in order to provide safe, efficient, and predictable care. The general anesthetic is given to your child by a specialist (anesthesiologist) and ONLY after the child has been thoroughly screened by a physician. Our academy (AAPD) recognizes the need for general anesthesia in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it.

Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care. Your pediatric dentist and his staff will discuss all the necessary steps that must be taken in order to promptly and safely complete your child's dental treatment after this treatment option has been chosen.

Like any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with an oral sedation include, but are not limited to: Allergic reaction, respiratory arrest, cardiac arrest, and death. Statistically, the chances of a serious complication are similar to those of being involved in a life threatening motor vehicle accident.Please make sure you fully understand as a parent or legal guardian all the risks involved with this procedure. Also review the instructions that you must follow the day before the procedure.

Can you do all the work at once with a Sedation?

In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule we also consider your child's comfort after he/she leaves the clinic, in order to determine how much local anesthetic we can use.

Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity they try to feel the area or areas that are numb.

For these and other reasons it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.

Will you need to give my child a shot to do the dental work?

This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic and numbs the tissue were the injection will be administered. Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth) it is very difficult to obtain profound anesthesia, however we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation). Younger children, particularly pre-schoolers may interpret the feeling of numbness as pain, and therefore cry. Please follow the postoperative instructions that we give you, in order to minimize complications such as lip biting.

My child

When a baby-tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose, however, this change is minimal and should not be confused with a carious lesion (cavity). The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist. Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the 'cavities' are large). Teeth with cavities typically assume a darker (brown) discoloration, and depending on the extent, may exhibit loss of tooth structure. Teeth that have been previously 'bumped' may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may-not be associated with pain. Other less common causes of changes in color may be: Fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

My child is getting shark teeth what can i do?

One of our most common consults occurs when children around the age of 7 begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth), however if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.

My child has crooked teeth, will he or she need braces?

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old. The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms we refer to this as Early Treatment. Early treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition, or in early mixed dentition (when the first permanent teeth begin to erupt). Early treatment has been proven to be effective despite objections by some people in the orthodontic community. The AAPD recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial esthetics.