Paedodontics (Children’s Dentistry)

Regular check-ups

Nurturing your child’s teeth during each stage of development is an important factor in their overall health.

Regular check-ups are important for the early detection of any current or potential future problems, which allows us to effectively prevent or treat them in their early stages. Early detection can prevent more serious dental problems when your child is older, which can result in more invasive and more expensive treatment.

At your child’s regular check-ups, we are also able to answer any of your questions and provide you with ongoing and comprehensive advice about your child’s oral health and development.

Whilst waiting until your child has a full set of teeth before they visit the dentist might seem sensible, children should have their initial dental check-up by their first birthday.

This will allow us to monitor your child’s dental health and development from a young age, and provide them with proactive and ongoing management of their dental health needs.

Preventative care and early intervention are the focus of our children’s dental services.

At your child’s dental appointments, we assist you in keeping their teeth and gums clean and healthy. This includes providing professional cleaning, education on oral hygiene and diet, and evaluation of their dental condition to identify if they require any preventative or supplementary treatments. We discuss age-related topics and can answer any of your questions or concerns regarding their oral care and development.

We also continually assess their dental development as they grow, to ensure the primary and secondary teeth develop correctly, and so we are able to provide early intervention if any problems arise.

Children’s dental appointments will not only include an exam and assessment, but our team will go out of our way to ensure they have a positive experience in our practice, and they will leave with a goody bag for their achievement. We provide a children’s play area, we conduct tours of the practice so they are comfortable in the setting, we give ‘rides’ on the dental chair, we have TV’s in the waiting room and surgeries with kids’ channels, we have iPads with games on them, and we allow them to interact with safe dental equipment.

During the appointment

Early childhood examinations will assess:

  • Current dental condition (including if there is any tooth decay).
  • Hereditary problems, for example malformed or missing teeth.
  • The need for preventative supplements, such as fluoride or fissure sealants.
  • Para-functional habits such as finger sucking and tongue thrusting.
  • The developing growth relation between the jaws, the tooth size to jaw size relationship, and the need for any orthopaedic appliance therapy.
  • The correct growth and development of the dentition and if there is any need for appliances to correct dental malalignment (such as braces).

We will also discuss, and provide advice on, topics including:

  • Hygiene techniques and instructions (e.g. brushing).
  • The risk of dental decay and how to prevent it.
  • Age-related information, such as teething and para-functional habits (e.g. thumb sucking).
  • Brushing techniques.
  • Bite (how your child’s teeth come together).
  • Nutritional advice.

Children’s preventative care

As they say, prevention is better than cure. We want to help your child keep their natural teeth for life.

Through regular oral hygiene cleans and assessments we can effectively treat, manage and maintain their oral health, which in turn supports their overall health.

Did you know that dental caries (tooth decay) is the most common chronic disease in children? It is about five times more common than asthma1. In New South Wales, 40% of children aged 5-6 years have evidence of dental decay, and yet the disease is mostly preventable2.

The enamel of baby (primary) teeth is less densely mineralised than the enamel of adult (permanent) teeth, making them more susceptible to tooth decay. Tooth decay is the main reason that children lose their baby teeth too early, and it is largely preventable by good oral hygiene practices and a healthy diet. The development of tooth decay in the baby teeth can also further increase your child’s risk of developing tooth decay in their adult teeth3.

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It’s a misconception that baby (primary) teeth aren’t as important as adult (permanent) teeth. Even though they eventually fall out, they are still extremely important for your child’s developing oral health and overall wellbeing.

Baby teeth are important because they:

  • Play a vital role in the proper alignment and spacing of adult (permanent) teeth. Baby teeth hold space in the jawbone to guide adult teeth into the correct position, and on a straight angle, when they erupt. When a baby tooth is lost too early, adult teeth can drift into the empty space when they erupt which can cause crowding and/or crooked teeth.
  • Assist in stimulating the normal development of the facial structure (bones and muscles).
  • Assist in the development of correct speech and pronunciation.
  • Ensure your child receives adequate nutrition (by being able to chew a variety of foods effectively).
  • Ensure your child is digesting food properly (by being able to break food down into small enough pieces).

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To read more about our children’s preventative care services, please click here.

Early education

We will assist you in teaching your child how to take care of their smile.

Early education on the importance of looking after their teeth can help children develop good oral hygiene habits for life.

Behaviours learnt while children are young (such as brushing, flossing, and the importance of diet and routine dental visits) can help ensure they have healthy teeth into adulthood and beyond. It can also mean less dental treatment and less dental cost over their lifetime.

Fissure sealants

Fissure sealants are a safe and effective supplementary treatment often provided to children to help prevent tooth decay.

Fissure sealants are a protective layer of resin applied to the chewing surface of the back teeth (molars).

Fissures are the grooves that occur on the chewing surfaces of the back teeth. Sometimes these fissures are too deep and may be difficult to clean with a toothbrush. This can lead to food, plaque and bacteria becoming trapped in the fissures and causing cavities.

Fissure sealants are made from tooth-coloured resin which flows into the deep grooves to fill them.

The sealant will act as a barrier to bacteria and food debris, and will make the tooth surface smoother and therefore easier to clean.

The application of sealants does not require any drilling or local anaesthetic, and multiple sealants can be applied in one appointment.

Fissure Sealants

 

Smile development and early intervention

Beginning routine check-ups when children are young allows us to assess the development of their dentition as they grow.

Our dentists closely monitor the growth and development of your child’s smile, bite and facial profile to identify and rectify any potential developmental problems early.

This can include problems such as tongue ties, cross bites, and crowded or missing teeth.

Early intervention can result in less invasive procedures when the child is older.

Some of our services include laser surgery, orthodontics (braces), and orthopaedics (functional appliances).

Dental misalignment goes beyond cosmetics. A misaligned bite can be harder to clean (leading to tooth decay), make it difficult to chew some foods, cause abnormal wear on tooth surfaces, affect speech development, cause improper breathing, and cause muscle tension and pain.

Children’s Orthodontics and Orthopaedics

Orthodontics is the branch of dentistry that focuses on the diagnosis, prevention and treatment of problems relating to the misalignment of teeth and jaws.

The technical term for these problems is malocclusion, literally meaning ‘bad bite’.

Orthodontic treatments involve the planning and use of corrective appliances (such as braces and plates) to bring the teeth and jaws into proper alignment. This improves the health, appearance and function of the teeth.

Our children’s orthodontic services include early intervention orthopaedics, functional appliances, and traditional braces.

When malocclusion is left untreated, it can lead to:

  • Tooth decay and poor oral hygiene.
  • Abnormal wear of tooth surfaces.
  • Chipped, fractured or broken teeth.
  • Excessive stress of gum tissue.
  • Discomfort.
  • Inefficient chewing and problems with digestion.
  • Clenching and grinding.
  • Chronic headaches.

A severely misaligned bite can also cause improper breathing (breathing through the mouth instead of through the nose). A misaligned bite may also lead to speech problems, inaccurate speech development, or a speech impediment.

What causes Malocclusion?

Malocclusion can be caused by a number of factors, including:

  • A mismatch in size between the upper and lower jaws.
  • A mismatch in size between the jaw and teeth.
  • Jaws that under or over develop (are too large or too small).
  • Premature or congenital loss of the primary (baby) teeth.
  • Childhood para-functional habits including thumb sucking, tongue thrusting and mouth breathing.
  • Prolonged use of a dummy (pacifier) or bottle during childhood.

What conditions can be corrected through orthodontic treatment?

Orthodontic treatment can correct conditions including:

  • Crowded teeth.
  • Crooked teeth.
  • Diastema (space between two teeth, usually the front teeth).
  • Multiple gaps between teeth.
  • Abnormal bite pattern of the upper and lower teeth.
  • Overjet (protrusion of the upper front teeth, also called ‘buck teeth’).
  • Overbite (when the upper teeth overlap the lower teeth, also called a ‘closed bite’).
  • Underbite (when the lower jaw protrudes forward).
  • Crossbite (where the upper teeth bite on the inside of the lower teeth. Can occur on one or both sides).
  • Open bite (where the upper and lower teeth don’t touch even when the mouth is closed).

Our children’s orthodontic services include:

Appliances:

Orthodontic treatment can involve the use of fixed or removable appliances, either instead of or in conjunction with braces or orthopaedics, such as:

  • Special fixed appliances to control para-functional habits such as thumb sucking or tongue thrusting.
  • Fixed or removable space maintainers to hold the space for permanent (adult) teeth if a primary (baby) tooth is lost prematurely, which can prevent crowding.
  • Jaw repositioning appliances which guide the jaws to close in a more favourable position.
  • Palatal expanders to widen the arch of the upper jaw, reducing or eliminating the need to extract healthy teeth, and to prevent crowding.

 

Braces:

Braces are metal or ceramic brackets that are bonded (glued) to the front of individual teeth.

A lightweight wire is then threaded through each bracket and held in place with elastic ligature ties. Bands may also be fixed around the teeth to act as anchors for the appliance, if required.

Braces exert even, constant pressure onto teeth in order to gradually and precisely move them into a desired position. They can be used to both straighten teeth and also to correct bite or jaw alignment problems.

Traditional braces use metal brackets with coloured ligature ties. Patients can choose the colour of the ties, and change the colour at each adjustment appointment if desired.


Orthodontics braces

Orthodontics coloured bands

(If preferred we do also offer ceramic brackets with clear ligature ties. They are a translucent material which creates a more natural look. However, generally our younger patients prefer the coloured option).

 

Dentofacial Orthopaedics:

What is orthopaedics?

Dento-facial orthopaedics is also known as early-intervention orthodontic treatment, or interceptive orthodontics. It is used in growing children to address and intercept developing dentoskeletal problems.

Orthopaedics focuses on the correct growth and relationship of the jaw and facial bones for proper dental development, whereas orthodontics focuses on the correct alignment of the dentition (teeth).

Orthopaedics involves the use of custom-made functional appliances (also called ‘plates’), that may be either fixed or removable. The appliances are used to guide and correct the growth of a child’s bone structure, and balance the jaw size and jaw relationship, to improve dental function, facial profile and facial harmony.


Orthopaedics plate 2

Orthopaedics plate 1

Early intervention takes advantage of the fact that a child’s jaw is still growing to change the size, shape and relationship of the bones that structure the face and jaws before they are fully developed.

This can correct jaw malalignment, treat poor oral (para-functional) habits, prevent or treat sleep disorders, create adequate space for adult teeth to emerge, and prevent tooth crowding. Orthopaedics can also prevent the need to extract healthy permanent (adult) teeth to create correct alignment. This creates a fuller and more complete bite when the child is older.

Orthopaedics is often used prior to (in conjunction with) orthodontic treatment. In these cases, orthopaedics is used in the first phase of treatment to improve the alignment of the jaws (and prevent extreme tooth movement). In the second phase of treatment orthodontics, such as braces and retainers, are used to correctly align the teeth and create a proper bite. The initial orthopaedic treatment reduces the severity of the problem and results in less involved orthodontic treatment, shorter treatment times, and improves the overall result.

However, orthopaedics can also be used as the sole treatment method for minor adjustments.

Benefits of orthopaedic treatment:

  • Improve the facial structure and create ideal facial symmetry.
  • Reduce or prevent the need for the extraction of otherwise ideal, healthy permanent (adult) teeth to create correct dental alignment.
  • Reduces orthodontic treatment time and can improve the result of orthodontic treatment (when implemented prior).
  • Can otherwise eliminate the need for orthodontic treatment (braces).
  • Decrease or prevent the need for surgical intervention to repair misaligned jaws.
  • Helps prevent more expensive and involved orthodontic and maxillofacial treatment later in life.
  • Prevent or treat sleep disorders (if airway is obstructed).

What conditions can orthopaedic appliances treat?

Orthopaedic appliances can prevent, treat, or reduce the development of conditions including or relating to:

  • Childhood para-functional habits including thumb sucking, tongue thrusting and mouth breathing.
  • A mismatch in size between the upper and lower jaws.
  • A mismatch in size between the jaws and teeth.
  • Retrognathism (where the mandibular – lower – jaw is set further back than the upper jaw).
  • Prognathism (where the mandibular – lower – jaw is extended further forward than the upper jaw).
  • Misalignment of the bone structure and jaws (crossbite, overbite, open bite).
  • Abnormal bite pattern of the upper and lower teeth.
  • Gaps between multiple teeth.
  • Diastemas (a gap between two teeth, usually the front teeth).
  • Crowding of the teeth.

Lingual (tongue tie) and labial frenectomies

A frenum, also called a frenulum, is a small fold of muscular tissue that prevents an organ in the body from moving too far.

There are two main frenums in the mouth: the lingual frenum (under the tongue) and the labial frenum (in the upper lip).

A frenectomy is a simple, minimally invasive surgical procedure performed to loosen, release or reshape a frenum that is malformed.

A lingual frenectomy will increase the range of motion of the tongue.

A labial frenectomy will assist in closing a gap between the upper front teeth.

Generally, the frenums are assessed from when children are young. If a frenum is malformed (too short, too long, or too rigid) it can cause developmental problems and movement restrictions as the child grows.

At VC Dental, we see patients as young as 6 weeks old to diagnose and rectify developmental cases.

Lingual and Labial Frenums diagram

Lingual frenum:

The lingual frenum is the band of tissue that connects the bottom of the tongue to the floor of the mouth.

If you lift your child’s tongue up, you will be able to see the lingual frenum underneath.

The lingual frenum is designed to connect the tongue to the jawbone, but if the frenum is too tight or too short (attaches too close to the tip of the tongue) it can restrict the movement of the tongue. This condition is commonly called a tongue-tie (ankyloglossia) and it can affect speech, swallowing, breast feeding and eating.

A tongue-tie may also inhibit correct jaw development, which can cause long-term orthodontic problems and/or lead to sleep apnoea.

Labial frenum:

The labial frenum is the small band of tissue that connects from the centre of the upper lip to between the upper front teeth.

If the labial frenum is too long it can create a large gap between the two front teeth, and/or cause gum recession as the frenum pulls the gums away from the teeth.

In rarer cases, if the frenum is too short/tight it can create an open-mouth position that inhibits the mouth from properly sealing. This can cause mouth breathing and improper development of the airway and jaw.

Procedure:

Whether our concern is the lingual or labial frenum, the procedure is generally the same.

It involves removing and/or reshaping the frenum to create a greater range of motion of the lips or tongue, and to allow for proper oral development and muscular function.

Laser surgery:

Lingual and labial frenectomies are minimally invasive procedures performed using laser surgery.

The use of laser technology for dental treatment is advanced, safe and highly effective.

The laser is ideal for precisely removing and reshaping soft tissue and it cauterises (seals off the blood vessels) at the same time. This helps to reduce or eliminate bleeding both during and after the procedure. The laser also provides a more sterilised treatment environment, and can result in faster treatment times, and quicker patient healing and recovery.

Laser surgery is quick, straightforward and is generally well tolerated under local anaesthetic (to numb the treatment area).

However, if preferred we do have sedation options available including inhalation sedation (‘happy gas’), oral sedatives and IV sedation to ensure the patient is comfortable for the duration of the procedure. You can read more about these options here.

Lingual frenectomy procedure:

In a lingual frenectomy the aim is to reduce the frenum in size to “release / free” the tongue-tie and allow for proper oral and muscular function including speech, swallowing and movement.

Labial frenectomy procedure:

A labial frenectomy can be performed in conjunction with orthodontic treatment to assist with closing a front tooth gap (diastema). It can also be used in growing children to prevent problems with the development of the airway, jaw and breathing patterns.

Preventing dental anxiety

Beginning dental visits at a young age provides early exposure to the dental environment, which can help prevent dental phobias later in life.

We go out of our way to make the dental visit experience as positive for your child as possible. For toddlers onwards dental visits include interactive experiences and building trust, such as practising opening their mouths wide and helping us count their teeth (after they guess how many they have). Children are praised throughout the appointments for their listening skills and ability to follow instructions.

For parents, you should refrain from using dental visits as a threat or deterrent for bad behaviour (such as not brushing teeth) whenever possible.

We actively encourage the early involvement of children in the dental environment, and we are happy for them to accompany parents or siblings to their appointments as well. Our friendly team are also happy to mind young children for parents during their own appointments. We will provide rides on the dental chair, the option to interact with safe dental equipment, and practice tours for small children which is a great way to introduce them to the setting with no expectations. We also have balloons, toys, iPads with games, and children’s TV shows to keep them occupied while you are in the surgery.

Sedation dentistry

We want your child’s dental visits to be as positive and comfortable as possible.

Our gentle and understanding team will go out of our way, and do our best, to keep your child confident and calm during appointments and procedures.

However, if you believe your child will become distressed having a procedure performed, we do offer sedation options for your consideration. Sedation can help your child to remain relaxed and calm for the duration of the procedure.

We are happy to discuss all sedation options with you, and find a solution that will work best for you and your child.

We are able to provide inhalation sedation (also known as ‘happy gas’), oral sedatives, and sleep dentistry IV sedation to children.

Inhalation Sedation:

Inhalation sedation is also called relative anaesthesia, happy gas, or laughing gas. It involves the use of nitrous oxide gas mixed with oxygen which is breathed in through the nose. It is administered quickly and easily by our experienced team through a small mask or nasal cannula.

This method of sedation provides a calm and relaxed state of mind for the duration of the procedure. Patients will generally experience a warm, pleasant, floating feeling. However, the patient will remain conscious, in control of their reflexes, and able to understand and respond to instructions.

The use of inhalation sedation is simple, effective and rapid. The gas only takes a few minutes to take effect and is easily reversed. Once reversed, the sedative wears off quickly with no lingering drowsiness or other side effects.

Nitrous oxide has no smell or colour and doesn’t irritate the airways. For children we can use scented masks (e.g. vanilla, strawberry or orange flavour) to make it a more pleasant experience.

Oral sedatives:

Oral sedation is a non-invasive method of inducing moderate sedation for most patients.

Oral sedatives will be given one hour prior to the appointment, in the form of a tablet.

The medication allows the patient to feel relaxed, calm and drowsy for the entire procedure. However, the patient will remain conscious, in control of their reflexes, and able to understand and respond to instructions.

The effects can last for a few hours after the procedure.

Sleep dentistry IV sedation:

Sleep dentistry involves sedative medication being administered intravenously. It allows us to perform dental procedures whilst the patient is in a deep state of relaxation, yet still conscious.

The sedation puts the patient into a drowsy, dream-like state of sleep. The patient will feel intensely relaxed and at ease for the entire duration of the dental procedure. The medication used produces a mild state of amnesia. This means the patient will have no memory or recollection of the entire procedure after ‘waking up’, and will feel like no time has passed.

Sleep dentistry is also called intravenous (IV) sedation, conscious sedation or twilight sedation.

At VC Dental, IV sedation is administered and monitored by a qualified anaesthetist practitioner who is specifically brought in for the appointment. This service is provided in our dental surgery so our patients don’t have to travel elsewhere for treatment.

Common children’s procedures performed under sleep dentistry sedation include fillings, tooth extractions and frenectomies.

If multiple dental treatments are required, we can perform them all in the one appointment under IV sedation, which may be more efficient.

There is no airway tube used in IV sedation.

A portion of the sedation cost can be claimed back on Medicare.

We bulk bill the Medicare Child Dental Benefits Schedule

What is the Medicare Child Dental Benefits Schedule?

The Medicare Child Dental Benefits Schedule is a Federal Government scheme that provides basic dental services to eligible children aged between 2 and 17 years.

Children can receive up to $1,000 worth of dental treatment over a two calendar-year period.

We bulk bill the Medicare CDBS

For any treatment covered under the Child Dental Benefits Schedule we bulk bill the patient, and invoice Medicare directly on their behalf.

This means there will be no out-of-pocket costs for the patient.

We will ask the parent or guardian to sign a form allowing us to claim the benefits from Medicare for the services provided.

What services are provided under the Child Dental Benefits Schedule?

A range of services can be provided under the CDBS including:

  • Examinations (check-ups)
  • Professional cleans (scale, polish and fluoride)
  • X-rays (radiographs)
  • Fissure sealants
  • Dental fillings (tooth coloured)
  • Tooth extractions
  • Partial dentures

Details of the Medicare CDBS scheme

For eligible children you can claim up to $1,000 for each child over two consecutive calendar years.

The two-year period starts at the beginning of the calendar year in which your child both:

  • Becomes eligible
  • Receives their first dental service

You can use the full amount ($1,000) in the first year if necessary. If you don’t use the full $1,000 in the first year, you can use the remaining funds in the second year if your child still remains eligible.

Your child is eligible throughout the entire single (1) calendar year, even if they turn 18 later in that year, or stop receiving the relevant payment during that year.

If you don’t use the full $1,000 within the two-year period, you can’t use the remaining funds.

If your child remains eligible at the end of the two-year period, their $1,000 benefit will be reinstated for a further two-year period.

Is my child eligible for the Medicare CDBS?

The Child Dental Benefits Schedule is means tested.

The Department of Human Services determines eligibility from the start of each year, and throughout the year.

A child is eligible if:

  • They qualify for Medicare (they must also be eligible for Medicare on the day the service is provided).
  • They are within the applicable age range (2-17 years) for at least some of that year.
  • The child or parent/guardian receives an approved Australian Government payment, such as the Family Tax Benefit Part A, for at least some of that year.

You do not need to register your child(ren) for the CDBS scheme. If your child(ren) are eligible, you will be automatically directly advised by Medicare. Notifications are sent either electronically or by post.

If at the end of the two year period your child(ren) remain eligible, you will receive another notification from Medicare and the $1,000 benefit will be reinstated for a further two calendar-year period.

To find out more about the CDBS program, to check whether your child(ren) are eligible, or to find out the remaining balance, you can:

  • Contact Medicare directly on their general enquiries line 132 011 (7 days per week, 24 hours per day)
  • Visit the Department of Human Services website by clicking here.
  • Log in to your Medicare online account by clicking here.

Booking an appointment with us under the Medicare CDBS

When booking your appointment please advise us if you/your child are eligible for the CDBS scheme.

We will ask you to provide us with your child’s Medicare number so we can confirm their eligibility and check their remaining balance for treatment.

Please also bring your child’s Medicare card to the appointment with you.

 

Please note, any surgical or invasive procedure carries risks. Before proceeding you should obtain personal advice from an appropriately qualified health practitioner.

This information is intended to provide patients with a general overview of the Medicare CDBS scheme. We do not guarantee that the information provided here is current or correct. Please refer to the Department of Human Services or Medicare for any information regarding the scheme, services or eligibility.

References

  1. Public Health Reports: Oral Health – The Silent Epidemic (2010)
  2. NSW Health: Early Childhood Oral Health Guidelines for Child Health Professionals, 3rd Edition (2014)
  3. Journal of International Society of Preventive & Community Dentistry: Do the more caries in early primary dentition indicate the more caries in permanent dentition? Results of a 5-years follow-up study in rural-district (2012)