1st Dental Visit
We understand that your son or daughter may feel anxious about visiting the dentist. We are sensitive to children’s needs and it is our goal to make your child feel comfortable visiting our practice while we provide the best possible care.
The current guideline from the Canadian Academy of Pediatric Dentistry (CAPD), in alignment with the Canadian Dental Association and the Canadian Paediatric Society, is that a child should have their first dental visit within 6 months of the eruption of their first tooth, or by 12 months of age (one year old), whichever comes first.
During your child’s first visit, we will review their dental and medical history forms, take X-rays of their teeth and mouth if needed, and one of our assistants may clean and polish their teeth. The dentist will check for any cavities or early signs of tooth decay or gingivitis. The dentist will then discuss the X-rays, help create an individual treatment plan, and answer any questions or concerns that you or your child may have. We have you stay with your child so that we gain your child's confidence and overcome apprehension.
For infants, or small children who are feeling nervous, we perform a "knee to knee exam" where the child sits on the parent's lap for the exam.
Bring your smile, but also remember to bring these with you to your child’s first appointment:
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Your child's Health Card
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Your insurance information
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The child's parent or legal guardian MUST be present for the first dental visit
A few tips before your child's first exam:
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You can make your child's first visit enjoyable and positive. If old enough, your child can be informed of the visit and told that the dentist and their team will explain all procedures and answer any questions.
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Remember to keep it positive for your child.
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It is best to refrain from using words around your child that may cause unnecessary fear, such as "needle," "shot," "poke," "yank," "pull," "drill," or "hurt." Pediatric offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
Regular checkups are an important part of maintaining a healthy smile!
The Canadian Dental Association recommends that children visit the dentist every six months for regular checkups and routine teeth cleanings to keep their teeth and gums healthy.
We understand that your family has a busy schedule, so when you’re preparing for a 1st dental visit, please remember that an appointment will last approximately 30 minutes.
Dental Exams with Cleanings & Fluoride
Preventing Problems Before They Start
The health of your child’s teeth and mouth is very important to the well-being of his or her entire body, and while routine brushing and flossing at home is necessary to keep your child’s smile looking its best, visiting the dentist for a comprehensive exam and cleaning is essential. The Canadian Dental Association recommends that your child visit the dentist every six months to ensure his or her teeth stay healthy and smile stays beautiful.
By routinely seeing the dentist for exams and cleanings, your child can:
· Prevent tooth decay, gum disease, and bad breath
· Avoid costly and extensive dental procedures
· Have white teeth by reducing staining from food and drinks
· Shorten the time spent in the dentist’s office
· Have a smile that will last a lifetime
The dentist may also want to take X-rays to see what is happening beneath the surface of the teeth and gums. The images provided in the X-rays will help the dentist discover dental issues not visible to the naked eye.
Receiving a fluoride treatment from your dentist
A fluoride treatment in the dentist’s office takes just a few minutes. After the treatment, patients may be asked to not rinse, eat, or drink for 15-30 minutes in order to allow the teeth to absorb the fluoride. Depending on your child’s oral health or your doctor’s recommendation, your child may be required to have a fluoride treatment every three, six, or 12 months. Your doctor may also recommend at-home fluoride mouthwash.
Dental Restorations and Sealants
If your child has a cavity, there are a few treatments the dentist will consider and explain to you.
Dental Fillings
If the cavity is small enough to support a dental filling, the dentist will clean out the decay and place a filling. After numbing, the decay is removed and the resulting clean hole is filled with a putty-like substance which hardens when exposed to the dentist's curing light.
Pulpotomy/Pulpectomy
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 one of two options, a pulpotomy or a pulpectomy.
Pulpotomy
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 inflamed material in the pulp of the crown only, leaving the nerve in the root intact. After a pulpotomy on a baby molar, the empty space will be filled with special medication and then a crown will be placed over the tooth to protect it.
Pulpectomy
If the infection involves tissue in both the tooth crown and the root, a pulpectomy may be the best option. In a pulpectomy, the entire pulp material is removed from both the crown and the root(s). After numbing your child’s tooth, the dentist will remove the pulp and nerve tissue from the crown and from the canals of the roots. Then, the pulp chamber and root canals will be thoroughly cleaned and disinfected. Next, the dentist will fill the tooth and tooth roots with a special medication, and finish with a crown.
Crowns
Teeth with decay that is too large to support a dental filling will require restoration with a stainless steel crown.
Crowns are “cemented” onto an existing tooth and fully cover the portion of the tooth above the gum line. In effect, the crown becomes the tooth’s new outer surface. 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.
Nitrous Oxide
Nitrous oxide, or laughing gas, is the most frequently used method for easing mild to moderate anxiety in children. Administered through a small mask that fits over your child’s nose, it is an effective way to calm anxiety. Your child will be asked to breathe through his or her nose and not through their mouth. As the gas begins to work, your child will become calm, although he or she will still be awake and able to talk with the dentist.
At the end of your child’s appointment, he or she will resume breathing regular oxygen, and all the effects of nitrous oxide will disappear. As your child gets older and becomes more comfortable during dental visits, nitrous oxide may not be necessary.
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 reach between the small cracks and grooves on 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 plastic resins that bond and harden in the deep grooves on the tooth’s surface. When a tooth is sealed, the tiny grooves become smooth, and are less likely to collect plaque. With sealants, brushing becomes easier and more effective against tooth decay.
Sealants are typically applied to children’s teeth after their permanent teeth (usually the molars) have erupted as a preventive measure against tooth decay. It is more common to seal permanent teeth rather than baby teeth, but every patient has unique needs, and the dentist will recommend sealants on a case-by-case basis.
Sealants last from three to five years, although it is fairly common to see adults with sealants still intact from childhood.
Dental Extractions & Space Maintainers
Dental 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. Other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.
While this procedure is typically very quick, it is important to share with your dentist any concerns or preferences for sedation; we want to make sure your child is as comfortable as possible.
Space Maintainers
If your child’s tooth has come out too soon because of decay, infection, 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.
A band-and-loop maintainer is made of stainless steel wire and held in place by a crown or band on the tooth adjacent to the empty space. The wire is attached to the crown or loop and rests against the side of the tooth on the other end of the space.
A lingual arch is used on the lower teeth when the permanent molars have erupted. A wire is placed on the lingual (tongue) side of the arch and is attached to the permanent lower molar bands on both sides.
A Nance appliance is used on the top teeth once the permanent molars have erupted. A wire with a plastic button on the palate is attached to the permanent upper molar bands on both sides.
The dentist will explain and show you examples of any space maintainers your child may require.
Caring for Your Child’s Space Maintainer
There are four general rules for taking care of your child’s appliance.
· Your child should avoid sticky foods, including hard candy and chewing gum.
· Encourage your child not to push or tug on the space maintainer with the fingers or tongue.
· Keep your child’s space maintainer clean through effective brushing and flossing.
· Your child should continue to see the pediatric dentist for regular dental visits.
Pediatric Dental Emergencies
If you face a dental emergency, give us a call immediately. If you need urgent treatment after hours, you can call our emergency number. We are always here to assist when your child’s dental health is at risk. Below are tips on dealing with urgent dental situations. You may want to display this list on your refrigerator or store it near your emergency phone numbers for easy reference.
Bitten Lip or Tongue
If your child has bitten their lip or tongue severely enough to cause bleeding, clean the bite gently with water and use a cold compress (a cold, wet towel or washcloth pressed firmly against the area) to reduce or avoid swelling. Give us a call to help determine how serious the bite is.
Object Caught In Teeth
If your child has something caught between their teeth, use dental floss to gently remove it. Never use a metal, plastic, or sharp tool to remove a stuck object. If you are unable to remove the item with dental floss, give us a call.
Broken, Chipped, or Fractured Tooth
If your child has chipped or broken a piece off of their tooth, have them rinse their mouth with warm water, then use a cold compress to reduce swelling. Try to locate and save the tooth fragment that broke off. Call us immediately.
Knocked Out Tooth
If your child’s PERMANENT tooth has been knocked out of the mouth, find the tooth and rinse it with water (no soap), taking care to only touch the crown of the tooth (the part you can see when it’s in place - AVOID TOUCHING THE ROOT). Replace the tooth in the socket if possible, otherwise, place the tooth in a clean container with milk. Call us immediately and/or head to the hospital. If you act quickly it's possible to save the tooth.
Toothache
If your child complains of a toothache, rinse their mouth with warm water and inspect the teeth to be sure there is nothing caught between them. If pain continues, use a cold compress to ease the pain. Do not apply heat or any kind of aspirin or topical pain reliever directly to the affected area, as this can cause damage to the gums. Children’s pain relievers may be taken orally. Schedule an appointment immediately.
Broken Jaw
If you know or suspect your child has sustained a broken jaw, use a cold compress to reduce swelling. Head to the hospital immediately. In many cases a broken jaw is the result of a blow to the head. Severe blows to the head can be dangerous and even life-threatening.
Avoiding Injury
You can help your child avoid dental emergencies. Child-proof your house to avoid falls. Don't let your child chew on ice, popcorn kernels, or other hard foods. Always use car seats for young children and require seat belts for older children. And if your child plays contact sports, have them wear a mouthguard. Ask us about creating a custom-fitted mouthguard for your child. Finally, prevent toothaches with regular brushing, flossing, and visits to our office.
Post Operative Instructions
Care After Local Anesthetic
If your child has had local anesthetic (numbing medicine or "marshmallow juice") for their dental procedure(s):
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in the upper jaw, the teeth, lip and surrounding tissue will be numb or "asleep"
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in the lower jaw, the tongue, teeth, lip and surrounding tissue will be numb or "asleep"
As the area "wakes up" it may feel funny. Often children do not understand the effects of local anesthesia and may bite, chew, scratch, suck or play with their numb lip, tongue or cheek. These actions can cause minor or sometimes severe irritation which can result in swelling and abrasion to the tissue. A self-inflicted bite injury is the most common post-op complication. Please monitor your child closely for approximately 1-2 hours following the appointment. It is often wise to keep your child on a liquid or soft diet until the anesthetic has worn off.
Care After Fillings or Crowns
Do not allow your child to eat hard foods for the first 24 hours. Avoid chewing ice and hard suckers or candies as these may cause fillings and surrounding tooth structure to fracture. If a stainless steel crown has been placed, your child must avoid sticky foods as well.
If extensive treatment has been performed, give Children's Tylenol or Children's Advil as directed on the package prior to the numbness wearing off. NEVER exceed the recommended dosage in a 24 hour period.
Care After Surgical Procedures
Keep gauze in place with biting pressure for 30 minutes. This will reduce the amount of bleeding.
Give your child the appropriate dose of Children's Tylenol, Children's Motrin or Children's Advil when necessary for pain. NO ASPIRIN.
Your child should eat only soft, bland foods for the first couple of days (mashed potatoes, eggs, macaroni & cheese, pasta, yogurt, soup, pudding, ice cream, popsicles, etc). Nothing sharp, crunchy or too hot. The treated area may be sensitive. Encourage plenty of liquids.
NO spitting, drinking through a straw or "sippy cup". The force can cause the area to bleed again.
A clean mouth heals faster. Gentle brushing around the site and warm salt water rinses (1/4 tsp salt in a glass of water) can be started the day after the surgery.
Activity should be limited the day of the surgery. Sometimes a nap is a good idea.
Mild swelling after a procedure is not uncommon and should not cause alarm. If this occurs, apply and ice pack to the child's face in the area of the swelling as needed, alternating 15 minutes on, 15 minutes off for the first 24 hours after surgery.
If stitches or surgical packing is placed, it will dissolve on its own in approximately 7-10days.
Care for Space Maintainers
Space maintainers are appliances cemented onto your child's teeth to prevent teeth from shifting and closing space needed for future adult teeth.
Avoid playing with the appliance(s) with tongue or fingers.
Avoid hard, sticky foods as these can break the cement bond.
Brush and floss normally.
Your child's speech may seem different at first until they become used to the appliance. Speaking or reading out loud can encourage faster adjustment.
Once your child's permanent tooth/teeth become visible in the space being maintained, the appliance needs to be removed.
If the appliance feels loose to the child, please call the office right away. A loose appliance can allow food and bacteria to become trapped under the band and cause decay.
Please do not hesitate to contact the office at 519-944-7779 with any questions or concerns.
Hospital Dentistry
As a pediatric specialist, we often see children with severe decay and those with dental anxiety, developmental delays and neurodivergence.
In cases where children are unable to tolerate treatment in the dental office, Dr. Durocher has hospital priviliges that allow her to safely treat patients while they are asleep under general anesthesia at the hospital.