Our Services
Age 1 Visits
Because cavities know no age boundaries, we recommend that your child’s first dental visit is around their first birthday or soon after the first tooth comes into the mouth. Both the American Academy of Pediatric Dentistry and the American Academy of Pediatrics recognize early childhood cavities as a health problem affecting a significant number of children and recommend that a child see a dentist at one year of age or 6 months after the first tooth comes in.
Your child’s first visit with us will allow for you to ask questions and gather information about how to care for your child’s teeth, how to prevent cavities, teething, oral habits, the role of diet and hygiene in cavity development. The examination allows for our pediatric dentists to evaluate your child’s medical history, child’s dental development and identify potential problems at an early stage. Most importantly, an age 1 visit allows your child to be introduced to dental care in a personalized and gentle way to help your child be comfortable and to accomplish something that may have seemed impossible.
Many times, the very young patient can be slow to warm up to the idea of being in the dental environment. We may ask that your child remain in your lap while the examination and additional care is provided. When the examination is complete, it will be time for your child to pick a prize.
Initial Exams
Whether this is your child’s first ever dental visit or the first one with our office, we will use this time to allow your child to get acquainted with the dental environment. The dental tools will be demonstrated to your child in an age appropriate manner. Depending on the age and comfort level of the child, it may be necessary to have a child sit in their parent’s lap while the teeth are being cleaned. This cleaning includes polishing the teeth, flossing, a fluoride treatment and x-rays when appropriate. This will be followed by an examination by one of our pediatric dentists and time for your child to pick a prize.
During this visit, we will get to know your child by reviewing the medical and dental histories and completing an examination which looks at: the overall health of your child’s mouth; the stage of dental development; the way your child’s teeth bite together and the presence of cavities or gum disease. We will discuss any questions or concerns that you may have, any oral health habits your child may have, and the findings of the examination.
Dental Care for Children with Special Health Care Needs
If your child has a complex medical history; physical, emotional or behavioral conditions or chronic health problems and is in need of dental care, please give our office a call. Dental visits can be challenging for many people, but even more so for those with special health care needs. As pediatric dentists, we have received additional training in providing dental care to those with special health care needs and are very comfortable treating children with special needs.
When scheduling the appointment, please tell us a little about your child so we can be sure that your child is as comfortable as possible during the dental visit.
Preventive Dentistry
Preventing your child’s cavities begins before your child has a tooth or has even been born…it begins with mom. The better a mom-to-be takes care of her teeth, sees a dentist and eats a healthy balanced diet, the better the oral health can be for your child.
When caring for your child’s mouth, begin before you can see the first tooth by massaging the gums with a brush or cloth. This establishes a routine for you and your child and allows your child to accept the idea of oral hygiene before the teeth begin to come in.
It is best to clean your child’s teeth at least twice a day. Initially, this can be done with gauze or a washcloth. As your child gets more teeth, you will want to graduate to a soft toothbrush and eventually, you will want to begin flossing.
The keys to preventing cavities include: regular dental visits; consistent home care; having a diet that limits sugary and starchy foods and drinks; drinking water regularly; fluoride; sealants and xylitol.
Sealants
A sealant is a thin liquid, tooth-colored plastic that flows into the grooves on the chewing surfaces of baby and permanent molars; thus, creating an impenetrable physical barrier to prevent bacteria from entering into the deep crevices found on the teeth to cause cavities. Sealants have been used for several decades and can significantly reduce cavities.
Fluoride
Fluoride, a naturally occurring mineral, can help strengthen teeth to either reverse or prevent the harmful effects of the acid produced by bacteria in the mouth. When using a toothpaste containing fluoride, it is best to use between a smear to pea-size amount on the brush.
Xylitol
Xylitol is a natural sugar that is structurally different than sugars that contribute to the development of cavities. This allows it to help prevent cavities rather than cause them. It is a by-product of human glucose metabolism and can be found in birch trees, raspberries, lettuce, corn cobs, nutshells and other natural sources. It is recommended to have a total of 4-10 grams of xylitol per day broken up into 3-5 times per day use. Too much xylitol can cause gastrointestinal upset.
PLEASE KEEP PRODUCTS CONTAINING XYLITOL AWAY FROM DOGS.
Hygiene
It is best to begin cleaning your child’s mouth before the teeth erupt. You can use gauze or a washcloth. Once teeth erupt, you can incorporate a soft bristled toothbrush with training toothpaste. As your child matures, you can introduce a toothpaste containing fluoride and/or xylitol and eventually floss. It is best to brush at least twice a day with the best time being after the last feeding or meal. Starting at a young age will help establish a routine for you and your child.
Snacks and Drinks
To maintain optimal health, it is best to limit frequent snacks rich in sugar and starch, frequent acidic drinks such as sports drinks, fruit drinks and energy drinks. We recommend drinking water after snacks and acidic or sugary drinks.
Regular consumption of acidic drinks can result in acid erosion. It is known that enamel can begin to breakdown at or below an acid level or pH of 5.5. Many sodas, even diet sodas, and sports drinks have a pH about that of stomach acid which is about 2.
Be aware that sugar has many aliases: sucrose, corn syrup, fructose, glucose, lactose, dextrose, hydrolyzed starch, high fructose corn syrup, maltodextrin, corn sweetner, molasses, malt syrup, honey, fruit juice concentrates and xylitol. These types of sugars are found in many common foods, be sure to read food labels and limit the amount of sugar your child consumes.
Remember, it is not just what you eat but how often you eat it. After eating or drinking, bacteria in the mouth process sugars and starches into acid. This occurs for 20 minutes and can take up to 2 hours for the saliva to dilute the acid. It may be best to limit juice consumption to meal time and to avoid carbonated beverages in the first 30 months. It is best to include foods containing sugar and starch at mealtime and not use them as a snack. Snacks should consist of foods that contribute to your child’s overall nutrition.
Dental Visits
We often recommend that your child return to our office twice a year for preventive dental visits. There are times that we may request to see you child more or less frequently depending on their specific dental needs.
X-rays
X-rays are a preventive tool as they can help us identify the presence of cavities and any tooth or bony abnormalities, evaluate the eruption sequence of the teeth and potential for crowding before a problem can be seen by the naked eye.
Current techniques utilized in taking x-rays and the use of lead aprons will limit the amount of radiation exposure. Dental disease that goes undetected and untreated can be more harmful to your child than the minimal exposure to radiation received when taking dental x-rays.
Restorative Dentistry
We know that, most, baby teeth will fall out but before that time, these teeth serve many important purposes: allowing your child to chew food into adolescence; assisting in speech; ‘holding’ space for the permanent teeth to come in properly; and giving your child a beautiful smile. Neglecting baby teeth can result in cavities, pain and infection. This can translate into sleepless nights, time your child misses from school and you miss from work, as well as, the expense of the appropriate treatment.
How a Cavity Begins
Certain bacteria living in the mouth ferment the sugars and starches that we eat resulting in the production of acid. If a tooth continues to be ‘attacked’ by acid, there will be a loss of minerals which can result in a cavity or hole in the tooth. As more and more acid is produced, the mouth becomes too acidic or ‘toxic’ for the healthy bacteria to survive which allows the harmful bacteria to take over. These bacteria stick to teeth and to each other forming plaque. Plaque is a bacteria-filled film that accumulates on all surfaces of the teeth. This allows for the acid to be concentrated at the tooth’s surface and protects the bacteria from the neutralizing action of the saliva.
The size of the cavity and the age of the patient will often determine what treatment is best:
• Cavities appearing as white spots on the teeth. A change in habits and use of pastes or rinses can strengthen the tooth and may prevent the need for fillings.
• Small cavities that can be seen in the mouth or on x-rays. These teeth will likely be treated with tooth colored fillings. In most cases, the tooth may need to be numb using ‘sleepy drops’.
• Cavities that are very large may not have enough healthy tooth structure to support a filling and will need to be fixed using a crown or a cap. For front teeth, we use tooth colored crowns and for back teeth we use stainless steel crowns which are silver in color. If the tooth has too little healthy tooth structure to support a crown, we will need to remove the tooth.
• Cavities into the nerves of the teeth, when appropriate, will require tooth nerve treatment. In these cases, it may be necessary to remove the tooth if the tooth is too sick to fix.
When back teeth have been removed before they are ready to come out naturally, it may be best that we preserve the space with a space maintainer. This space maintainer will keep the space open for the permanent tooth that comes in to replace the extracted baby tooth. If your child requires that a tooth be removed, we will determine if your child would benefit from a space maintainer.
Sedation Dentistry
For patients that may have some anxiety about having their teeth fixed or may have a difficult time sitting still for the amount of time it takes to fix the teeth, it may be helpful to use medications to make the appointment easier.
Laughing Gas
Laughing gas (nitrous oxide and oxygen) is breathed in and out through a scented mask that rests on the nose. Laughing gas is quite safe and is helpful at relaxing patients that are breathing in and out through their nose. Laughing gas is not a medication that will induce sleep.
Oral Sedation
Mild sedatives can be provided to your child in our office to help your child through a dental appointment. The medications that we use are not intended to have your child fall asleep.Your child’s level of awareness may be altered but they will still experience the dental appointment. We have different medication options and, together, we can choose which one may be right for your child.
Intravenous Sedation
Choosing this method of treatment will ensure that your child receives comprehensive dental care in a safe and non-stress provoking manner. Because your child’s dental care will be provided under IV sedation, your child will be unaware of the length of treatment time, treatment events and the number of cavities treated. This helps prevent the development of future concerns surrounding dental care. Dental care is provided in our office with an anesthesiologist administering medications to your child while one of our pediatric dentists treats all of your child’s cavities.
Hospital Dentistry
When a child has an age related inability to cooperate for dental care in the office setting, has many teeth that need to be fixed, has significant dental fear or has complex medical conditions making them a poor candidate for sedation in the office, we will suggest that this child receives comprehensive dental care in an operating room at one of the local hospitals. Our doctors have privileges at either Seattle Children’s or Swedish Medical Center.
When in the operating room, an anesthesiologist will give your child medications that will have your child fall asleep before the dental treatment is started. While sleeping all of your child’s cavities will be treated.
Emergency Care
We are available to all patients for emergency dental appointments during our business hours, please call (425) 392-4048. After hours emergency care is available for patients of record. If your child is a patient of record and is experiencing a dental emergency, please call one of our dental staff at (425) 890-7017.
Here is some information that may help you determine if your child needs urgent dental care:
Cavities and Toothaches
If you have noticed a dark spot on a tooth and your child has little to no pain, no difficulty eating or sleeping, please call our office during business hours to schedule an appointment for an evaluation. Be sure to brush and floss the area to keep it clean.
If your child is complaining of a toothache that is interfering with eating and sleeping, your child has a fever and/or a swollen face, please call our office or the emergency after hours number to speak with a member of our staff.
Traumatic Injuries
Children are known to fall down and crash into things. Sometimes these incidents result in trauma to the mouth or teeth. In cases where your child has suffered a head trauma and loses consciousness, has blurred vision, dizziness or vomiting, please take your child to the nearest emergency room or call 911.
Injuries to the Skin, Lips, Cheeks, Gums and Tongue
These injuries can include bruising, abrasions or scrapes and shallow or deep cuts. For these types of injuries, apply pressure to stop bleeding, apply cold to reduce swelling and clean the wound. If you are unable to adequately clean the wound, there is severe swelling or you are unable to stop the bleeding, contact your medical doctor or our office for assistance. Some serious injuries may require stitches.
Injuries to the Teeth
These types of injuries can result in the following changes to the teeth:
• Sensitivity with biting and/or abnormal loosening. There may be some bleeding from the gums. Treatment often includes a soft diet for 2 weeks. It will be best to contact our office within the first 24 hours following injury to see if further treatment is needed.
• Tooth is now in a different position. There may or may not be bleeding from the gum tissue. Treatments may vary for baby and permanent teeth. It will be best to contact our office to see if further treatment is needed.
• Tooth is completely knocked out of its socket. There will be bleeding from the gum tissue. If this is a permanent tooth, carefully pick the tooth up by the crown. If the tooth is dirty, gently rinse the root with cool tap water for 10 seconds. Be sure to put a towel over the drain. Do not scrub the root. If possible, insert tooth back into its socket and have your child bite on a towel to keep the tooth in place. If you are unable to get the tooth back in place, put it in milk or place it in the mouth until you get to our office. It will be best to seek care immediately after the injury. Please do not forget the tooth at home.
The faster the tooth gets back in place, the greater chance for a successful outcome. Please do not transport the tooth dry or forget to bring it with you to the office. Treatment is dependent on the total time the tooth is out of the mouth.
• If this is a baby tooth, DO NOT put the tooth back in its socket.
Injuries to the Tooth and Nerve
These injuries may result in the following:
• Incomplete fracture of the enamel. There will be no tooth loss, but a hairline crack may be noticeable. Usually, no treatment is needed. An evaluation is recommended after the first 24 hours following the injury.
• Fracture of crown or a chipped tooth. Loss of tooth structure is noted. Treatment depends on the extent of the chip. An evaluation is recommended after the first 24 hours following the injury.
• Fracture of the enamel and dentin involving the nerve of the tooth. Loss of tooth structure is noted. The center of the fracture is red in color. Typically, the tooth is acutely sensitive. Treatment involves nerve treatment and bonding the tooth. It will be best to call our office within the first 24 hours following the injury.
Teeth that have been injured will require years of monitoring for changes in color and symptoms. Nerve testing may be done to monitor the vitality of the tooth. The more severe the injury, the more likely the nerve in the tooth may become necrotic (or die).
If your child is active in sports activities traumas to the mouth and teeth are more likely to occur. It is for this reason, we recommend that you inquire about a mouthguard to help prevent dental traumas.
Injuries to the Tooth, Nerve and Supporting Bone
These types of injuries can result in:
• Fracture of the crown, root or bone which may or may not involve the nerve. There will, likely, be pain with biting, sensitivity to air and extremes in temperature. There may be bleeding from the gum tissue. The extent of the fracture will dictate the type of treatment. Treatments may vary for baby and permanent teeth. It will be best to contact our office to see if and when treatment is needed.
• If you have the fractured piece of tooth, we may be able to bond it to your child’s tooth so be sure to bring it to the appointment.
Teeth that have been injured will require years of monitoring for changes in color and symptoms. Nerve testing may be done to monitor the vitality of the tooth. The more severe the injury, the more likely the nerve in the tooth may become necrotic (or die).
If your child is active in sports activities, traumas to the mouth and teeth are more likely to occur. To prevent or lessen the severity of a trauma to the mouth or teeth, we recommend that your child wears a mouth guard.
Oral Habits
Non-nutritive sucking is considered normal in the first few years of life. Thumb or digit sucking and use of a pacifier may be soothing to your child. The frequency, duration and strength of the sucking reflex can cause alterations in jaw shape and tooth position. The severity of these changes will determine whether self correction will occur with cessation of the habit and the eruption of the permanent teeth or if orthodontic intervention will be necessary in the future.
Pacifiers
One should consider the following when selecting a pacifier: it should be made from non-toxic material; it should be one piece with a soft, symmetrical nipple; it should have a contoured shield which is wider than your child’s mouth. The shield should have air vents; it should be dishwasher safe to allow for easy frequent washing; and it should be the proper size for your child.
Do not tie a pacifier around your child’s neck, hand or crib. Occasionally, inspect the pacifier for signs of over use. Do not use the pacifier to delay meals. One should never dip the pacifier in sweet substances. One should never substitute a bottle nipple as it is a choking hazard.
Thumb or Digit Sucking
The need to suck is present even before we are born. Many will suck their thumb for a short time and will self wean before or during the preschool years. If your child does not self wean by 5 years old, suggestions for stopping will be discussed with you. It is important to not ‘pressure’ your child into quitting; rather, offer words of praise when the child is not sucking and allow stopping to be their decision, suggest activities that will engage your child if the thumb sucking habit is now due to boredom. Remember, changes in family structure and dynamics or changes to routine may contribute to continuation of the habit.
Bruxism (Grinding)
Studies report that 15-33% of children grind their teeth. It can begin when a child is very young when the nerve/muscle complex is immature and will usually disappear as your child matures and begins to get more permanent teeth. Grinding while sleeping or during a change in depth of sleep is most common. Most grinding will stop without intervention.
Nail/Lip Biting
For most biting the nails, cheeks and/or lips is just a bad habit. When this is constant and severe, these biting habits may be a sign of anxiety or compulsive behavior.
Treatment may include behavioral therapy to help your child stop the biting habit.
Mouth Breathing
We all experience periods where we are unable to breathe through our nose. Many times this change from nasal to mouth breathing occurs secondary to a nasal airway obstruction. This can be from allergies, illness, large adenoid tissue and anatomical variations.
Some professionals debate the effects that chronic mouth breathing may have on the growth of the face. It is believed that chronic mouth breathing may result in a longer and more narrow face. We do know that mouth breathing can dry the mouth out which contributes to bad breath and makes it easier for plaque to accumulate on teeth.
Custom Made Mouthguards
Participation in sports is an excellent way to maintain a level of fitness, learn to become a team player, boost self esteem and confidence. Unfortunately, all sports have an associated risk of injuries to the face and mouth due to falls and collisions.
The American Dental Association (ADA) has reported that an athlete is 60 times more likely to have an injury to the teeth when not wearing a protective mouthguard. The ADA also reports that greater than 3.5 million children 14 years of age and younger are injured while playing sports or participating in recreational activities.
What Does an Athletic Mouthguard Do?
Mouthguards help cushion the teeth and mouth from traumatic injury for both adults and children. Often, mouthguards are required for youths playing contact sports such as football, boxing, hockey and lacrosse. We see many dental injuries in patients participating in recreational and organized sports such as basketball, baseball, bicycling, gymnastics, martial arts, skateboarding, soccer and volleyball and, therefore, encourage the use of a mouthguard for all these types of activities.
A mouthguard is a molded plastic material that is usually placed on the top teeth and acts like a ‘shock absorber’ to help prevent injuries to the teeth and face. Just like helmets are worn to protect against injury, use of a mouthguard can help prevent injury or decrease the severity of the injury.
Mouthguards Worn at Night
Patients that have a grinding habit while sleeping may request a guard that can be worn at nighttime. These guards can be custom made or a store bought athletic mouthguard that you modify at home to fit into your child’s mouth.
Community-Based Oral Health Program
An assistant will visit your school or mom's group to provide educational materials and information that supports good oral health. Please contact our office (425) 392-4048 for more information.
Field Trips & In-Office Tours
We would love for you to visit our office.
We can arrange for pre-school class, moms groups and other child-based organizations to be given a tour of our office, group oral hygiene instructions and an introduction to the dental “tools”. Please call our office (425) 392-4048 if you are interested in a tour.