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General
Q: Why is it so important to treat baby teeth if they are going to fall off and get replaced by adult teeth?

A: Baby teeth (primary teeth) start developing during pregnancy well before your child was even born. They start erupting as early as 6 months (or earlier) and they are there for very good reasons. Baby teeth help your child chew his or her food to contribute in providing nutrition at a time which is very critical for their growth and development. Anterior baby teeth contribute to your child’s speech development and appearance. Posterior baby teeth guide the eruption of the adult teeth and more importantly, they preserve the space which the adult teeth need, to erupt in their proper positions. Therefore, they play a critical role in preserving the integrity of the dental arch. Early loss of a posterior primary (baby) tooth or teeth (without proper space management) is very likely to cause partial or total loss of the space allocated for the perspective adult teeth, which will result in diversion of the eruption of those teeth or even their impaction (failure to erupt). Therefore, it is very important to maintain the health of your child’s primary (baby) teeth, treat them and restore them (when possible) and maintain their function if they were deemed to be removed due to extensive dental disease.

Q: When should I bring my child for his or her first dental check up?

A: According to the recommendation of the American Academy of Pediatric Dentistry, children should have their first dental appointment by their first birthday. Many early dental problems can be prevented with an early evaluation of your child’s dentition and eating habits. Important tips and diet recommendations at this first visit are a key in protecting your child’s oral health.

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A: Kids Dental Care’s prevention program includes the following (by order of importance):
o Diet counseling to the parents of young children and to the older children.
o Extensive and detailed oral hygiene instructions.
o Periodic professional topical fluoride application and home fluoride regimens if needed.
o Pits and fissure sealants
o Periodic oral exams.

Q: What are “Sealants”?

A: Pits and fissure sealant is a protective coating in the form of a liquid resin material that is allowed to flow into the deep pits, fissure, crevices and grooves of the chewing surface of permanent molars after being cleansed and etched, then cured (hardened) and therefore bonded to the tooth surface. Sealants are applied at Kids Dental Care in a unique way which allows them to bond better to the tooth surface and provide your child’s teeth with excellent protection for many years to come.

Q: My child brushes twice a day and still gets cavities, why is that?

Although brushing is very important, it is not the most important determining factor on whether your child will get cavities or not. The most important causative factor for tooth decay is dietary habits such as snacking patterns and the frequency of introducing sugar to the mouth. Remember that quantity doesn’t matter, what matters is the frequency. Every time you give your child a sip of juice or milk (even unsweetened or diluted) you are introducing a type of sugar to the mouth which will cause the oral bacteria to produce acid that will start decalcifying tooth enamel within 10 minutes. Same thing applies to cookies, candies, chewing gum, cake, etc. The worst type is the sticky kind of candy such as gummy bears, fruit loops, starburst, etc.

Q: I had my child examined by two different dentists and they both gave me conflicting reports on how many cavities she had, why is that?

A: Cavities detection is a process in which a dentist uses both visualization and tactical feel using a caries detecting instruments called ‘the explorer’. The explorer is an instrument with a fine tip that is pushed gently onto suspected areas of the tooth and the general chewing surface to determine if there is ‘stick’ or a ‘catch’. A ‘stick’ means that there is softness in the, otherwise hard tooth enamel, which caused the explorer’s fine tip to stick. A stick is usually indicative of a cavity. If the explorer’s tip is dull then it could easily miss a small cavity which can only be detected with a fine tip. Therefore, conflicting reports may arise from different examiners if they are using instruments that vary in sharpness. Additionally, some dentists elect not to treat the very small cavities because they prefer to wait for them to get bigger to justify drilling the tooth surface. As we strive for excellence and prevention at Kids Dental Care, we ensure the use of sharp fine detecting instruments and we treat small cavities conservatively, many times without local anesthesia, by minimal conservative drilling of the pin size site of the cavity while sealing the remaining part of the tooth to protect it. This is also referred to as Preventive Resin Restoration or PRR and is certainly a better option than drilling the whole surface of the tooth and filling it with a standard filling.

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Behavior Management
Q: How do you deal with anxious or fearful children in your practice? And what are the methods that you use in calming them?

A: Calming the fearful child is an expertise which comes with years of education, training and experience. Some of the most common behavior management techniques that are used include: "tell-show-do", positive reinforcement, distraction and voice control.
In tell-show- do, The dentist or assistant explains to the child what is to be done using simple terminology and repetition and then shows the child what is to be done by demonstrating with instruments on a model or the child’s or dentist's finger. Then the procedure is performed in the child's mouth as described. In positive reinforcement, every opportunity is taken to praise and reward the child's positive behavior. Distraction methods are used to distract the child from focusing on what he or she perceives as a source of anxiety. Voice control is a change in the tone or increasing the volume of the dentist's voice to indicate firmness, to gain the child attention and to assert authority. Content of the conversation is less important than the abrupt or sudden nature of the command. Your child’s behavior is evaluated when he or she is presented to Kids Dental Care either for the first visit or for the first dental procedure and the appropriate behavior management technique is utilized accordingly.

Q: Are parents allowed to stay with their children in treatment rooms during dental procedures?

A: At Kids Dental Care, parents are welcome to stay with their children in treatment rooms if they chose to. While we do encourage parents to accompany their children and stay with them at all times during their first visit and subsequent periodic check up visits, our professional recommendation is that parents remain in the waiting room when their children who passed the age of separation anxiety (3 years old) visit us for a dental procedure. It is a well known fact that most children do much better if their parent is not present with them during treatment. However, there is an exception to every rule. Sometimes, the parent presence is helpful and if that is the case, the parent will be asked to join the child in the treatment room.

Q: What if behavior management doesn’t work for my child, and he or she remains overly anxious?

A: Although behavior management techniques including the above mentioned ones, work for most children, some children who already suffer from deep-seated anxiety or high levels of fear or the very young ones are better treated under general anesthesia in the operating room (in the hospital). Dr. Ammar has operating room privileges at Connecticut Children Medical Center, the Hospital of Central Connecticut and Bristol Hospital and has treated many children under general anesthesia in the past.

Q: What is your office policy regarding physical restraint or holding children down?

A: Kids Dental Care is against the use of the so called "Papoose Board" or other forms of physical restrain. The only occasion where Dr. Ammar uses physical retrain is if the child needs a simple procedure that is not expected to take more than 5 minutes to complete, or in cases of an emergency, and in such cases, the parent is asked to restrain the child while talking in a soothing voice to eliminate the trauma of being restrained by a stranger.

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Orthodontic
Q: What is the proper age for my child to get orthodontic treatment (braces)?

A: Treating malocclusion is a very important aspect of the comprehensive treatment delivered to your child at Kids Dental Care. The timing of initiation of orthodontic treatment depends primarily on the type of malocclusion your child is presented with. In many cases we need to wait until all the permanent teeth are fully erupted before we start orthodontic treatment. However, in certain cases, such as the cases of children who have significant skeletal discrepancies, orthodontic treatment is better initiated at an early age, while your child is still in the stage of growth and development. Early orthodontic intervention, such as growth modification treatment, may eliminate the need for future jaw surgery treatment which might be needed to achieve proper functional and esthetic results.

Q: When is the best time to begin orthodontics?

A: Although Dr. Ammar can enhance a smile at any age; there is an optimal time period to begin treatment. Beginning treatment at this time ensures the greatest result and the least amount of time and expense. The American Association of Orthodontists recommends that the initial orthodontic evaluation should occur at the first sign of orthodontic problems or no later than age 7. At this early age, orthodontic treatment may not be necessary, but vigilant examination can anticipate the most advantageous time to begin treatment.

Q: What are the benefits of early orthodontic evaluation?

A: Early evaluation provides both timely detection of problems and greater opportunity for more effective treatment. Prudent intervention guides growth and development, preventing serious problems later. When orthodontic intervention is not necessary, an orthodontist can carefully monitor growth and development and begin treatment when it is ideal.

Q: Why is age 7 considered the optimal time for screening?

A: By the age of 7, the first adult molars erupt, establishing the back bite. During this time, Dr. Ammar can evaluate front-to-back and side-to-side tooth relationships. For example, the presence of erupting incisors can indicate possible overbite, open bite, crowding, or gummy smiles. Timely screening increases the chances for an incredible smile.

Q: What are the advantages of interceptive treatment? 

A: Some of the most direct results of interceptive treatment are:
• creating room for crowded, erupting teeth
• creating facial symmetry through influencing jaw growth
• reducing the risk of trauma to protruding front teeth
• preserving space for unerupted teeth
• reducing the need for tooth removal
• reducing treatment time with braces.

Q: What is comprehensive orthodontic treatment?
A: Complete orthodontic treatment to correct a malocclusion with upper and lower braces for at least 2 years.

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