Routine and Diagnostic:

We follow the American Academy of Dentistry and American Academy of Pediatric Dentistry guidelines for taking dental X-rays. Dental x-rays will be taken as needed during their routine cleaning appointments to check for cavities in between their teeth, survey erupting teeth, diagnose bone disease, evaluate the results of an injury, or plan orthodontic treatment. We will always minimize your child’s radiation exposure by providing 100% digital equipment that uses 90% less radiation than traditional dental x-rays and prescribing x-rays on an individual basis which depends on your child’s individual risk factors for oral disease. Your child will also wear a lead body apron with a thyroid collar during the process. If you have any concerns about x-rays for your child, please discuss them with our staff.

The American Academy of Pediatric Dentistry and American Academy of Pediatrics recommends every child see a dentist by the time their first tooth erupts and no later than their first birthday. Establishing a dental home early will encourage healthy habits that last a lifetime and ensure that your child receives preventive care. Routine dental cleanings and exams are important for your child to maintain good oral hygiene and prevent tooth decay and disease. Your daily home care is also critical, but the professional cleanings remove mineralized plaque that can develop despite good brushing and flossing, particularly in areas that are difficult to reach.

During the appointment, your child’s teeth will be polished and scaled to remove the plaque and tartar from the tooth surfaces and under the gum line. He or she will get to choose a fun toothpaste flavor like cookie dough or bubble gum before sitting back to watch a kid-friendly movie overhead while their teeth are cleaned. The hygienist will spend time reviewing your child’s dietary intake and daily dental hygiene routines. She will encourage healthy eating habits and instruct proper brushing and flossing techniques at each check up visit.

The last and best part of your child’s routine cleaning appointment is a thorough examination with either Dr. Loren or Dr. Natasha. They take the time to get to know every child and form lasting relationships with your child.

The exam includes visual examination of your child’s teeth and mouth, “counting” and “exploring” your child’s teeth and talking to your child about their teeth and hygiene. If your child has decay or other problems requiring treatment, the dentist will discuss them with you and a treatment appointment will be set for a later date.

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Positive attitudes and feelings toward the dental visit are encouraged. We strive to make each visit fun and have our patients leave happy. Your child will leave the office with a new cool toothbrush and great flavored toothpaste as well as an awesome prize.

Preventative:

Chelsea Pediatric Dentistry focuses strongly on prevention and wants to help our patients grow up cavity-free. We strongly encourage you to have your child’s teeth sealed because it is one of the most effective and easy ways to help prevent tooth decay. Dental sealants act as a barrier to prevent cavities and can be applied to baby molars and adult premolars and molars. They should be applied as early as possible after the adult tooth erupts and before cavities get a chance to form. The chewing surfaces are the most likely areas to get cavities and toothbrush bristles cannot reach all the way into the depressions and grooves of back teeth. Sealants protect these vulnerable areas by “sealing out” plaque and food. Sealants generally last several years and the cost of sealants is very low compared to getting cavities fixed.

Once your child starts playing competitive sports such a hockey, basketball, football etc. we strongly recommend that they wear a sports mouth guard to protect their adult teeth from fracturing due to trauma. While over-the-counter sports guards are readily available, the comfort and fit of a custom-made sports guard is unparalleled.

A Fluoride treatment in the form of a varnish (a sticky coating which minimizes ingestion) will be applied to your child’s teeth at the end of each check up visit or more often depending on their cavity risk. Your child will be able to eat and drink right away, just nothing hard or sticky or too hot for 4-6 hours. Fluoride is a safe and effective way to help your child’s teeth stay strong and cavity-free. We will also discuss optimal fluoride intake from all sources; i.e. Fluoridated water, toothpaste and mouth rinsing to help keep your child’s teeth strong while minimizing the risk of Fluorosis (white or brown spots) on their developing adult teeth.

When a tooth is lost prematurely due to cavities or trauma, a spacer is often recommended to hold the gap open for the adult tooth to erupt later when it’s ready. Space maintainers help prevent shifting and crowding of the adult teeth.

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If you child has a non-nutritive sucking habit such as thumb, fingers, pacifier, lip or tongue sucking that is causing damage to the oral structure (i.e. abnormal shape of mouth, protruding teeth or bite opening or shifting), we offer many types of custom-made oral appliances to help your child stop these harmful habits if traditional counseling and positive reinforcement strategies are not successful. We never make your child feel bad or embarrassed but instead offer positive encouragement that leaves them feeling empowered and in control; thereby, motivating them to want to stop the harmful habit.

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Restorative:

A Stainless Steel or White Zirconia Crown may be recommended for your child after a baby root canal is performed or if there is extensive damage to a back baby tooth from cavities or trauma. They are recommended when a traditional filling is not considered strong enough to protect the tooth until it will naturally fall out. (Keep in mind that the baby molars do not fall out until 11-14 years of age) The difference between stainless steel and white crowns is mostly cosmetic but the pros and cons to each crown can be discussed with your child’s doctor prior to placing it.

crowns

A cavity that involves the nerve (pulp) of the tooth may cause a child to experience intense pain. Although the pain may actually subside for a period of time using ibuprofen or antibiotics, it will return unless the tooth is properly treated. When the nerve of the tooth is infected, it must be treated to restore the child to good dental health.

A pediatric root canal procedure is referred to as a “pulpotomy.” The purpose of root canal treatment is to maintain the vitality of the affected tooth so that the tooth will not be lost early. Early loss of posterior (back) primary teeth may cause future problems with the eruption of permanent teeth. Therefore, it is best to avoid early loss of primary molars by properly treating the nerve of infected teeth with a pulpotomy. Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. The pulpotomy root canal procedure removes the infected pulp tissue within the crown of the tooth. A medication is placed to calm the nerve of the tooth and prevent bacterial growth. The pulpotomy is followed with a final restoration such as a filling, a white zirconia crown or stainless steel crown.

After the pulpotomy (root canal procedure) is complete; your child should feel much better. We expect all pain to subside either immediately or within a few days of the procedure.

extraction

A dental extraction, which is often referred to as getting a tooth pulled, is a common procedure performed by pediatric dentists. Extractions may be necessary due to extensive dental cavities causing pain or infection, dental trauma or for orthodontic reasons. Most extractions are easy and routine and can be performed within the comfort and familiarity of our office. If Dr. Loren or Dr. Natasha feels that the extraction is more complicated, your child may be referred to an Oral Surgeon.

In order to ensure that your child has a pleasant experience we recommend both Nitrous Oxide (to help them relax) and a local anesthetic (to numb the area). Rarely will your child require stitches. The area will heal on its own. It is important that you monitor your child so that they do not bite their lip or tongue. If there is sustained bleeding at home, try placing cotton gauze over the extraction site and have your child bite firmly for 30 minutes. You may also wet a tea bag and have your child bite on it gently. The tannic acid will stop bleeding naturally within 15 minutes. Have your child keep their fingers out of their mouth. Your child may eat a soft diet as soon as the numbness wears off, avoiding acidic food and drinks, such as tomato sauce and orange juice. Do not drink from a straw for the first 48 hours. Brush the area carefully and gently. Your child should relax after surgery, as strenuous physical activity may increase bleeding. You may start rinsing with a warm salt-water solution after 24 hours. Make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (237 mL)] of warm water. Give your child Tylenol or Motrin as per label instructions to control any discomfort they may experience. Return to the office in 7 days for follow up.

If you have any concerns about pain, bleeding or healing, contact us immediately.

We care about the safety of dental materials and will not place mercury containing silver (amalgam) fillings. Instead we place BPA-free white (composite fillings) which are safe and aesthetic. They look so great that no one will know your child had a cavity. SHHH!

Emergencies:

If your child is experiencing a true dental emergency, you can always call our office at 212-243-5437 and you will be given a number to contact either Dr. Natasha or Dr. Loren directly. We are always available to answer to emergency situations for our patients 24 hours/day, 7 days/week.

If your child is experiencing a toothache, first clean the area of the affected tooth thoroughly. Try to dislodge any food particle or debris that might be stuck in the tooth by rinsing vigorously with warm water and using dental floss. You may give your child tylenol or motrin as directed, but DO NOT place aspirin on the tooth or gums. If the face is swollen, apply cold compresses and call our office immediately. This could be a sign of a serious dental infection that requires prompt treatment.

Unfortunately, children sustain a fair amount of dental and facial trauma from sports-related injuries, falls and other accidents. The most important thing you can do as a parent is remain calm. If your child knocked out a permanent tooth, timely management (see below) is key to maintaining the life of the tooth. Depending on the nature and severity of the trauma, we may be able to effectively treat the traumatic injury in our office or even advise you on the at-home management over the phone (for less severe injuries) until you can make it in to our office. If your child has suffered a true medical emergency that involves more than just the mouth and peri-oral structures, call 911 or bring your child to the Emergency Room of your local hospital.

Reinserting an Avulsed (Knocked out) Permanent Tooth:
  1. Find the tooth and do your best to hold it by the crown rather than the root.
  2. You may gently rinse the tooth with saline or milk to remove any debris, being careful to only touch the crown of the tooth. NOTE: Do not rinse the tooth with water.
  3. If the entire root is still intact, try to reinsert it in the socket. If that is not possible, put the tooth in a glass of milk and take your child and the glass immediately to your pediatric dentist.

*Please note that baby teeth are generally not reinserted into the socket due to the risk of damage to the developing permanent tooth beneath it, however your child should still be seen by your pediatric dentist promptly.

Cosmetic:

Sometimes a white composite “filling” is required to restore the esthetics of a front tooth that has sustained a traumatic injury or suffers from one of the many developmental abnormalities that can affect the coloration of adult teeth. Unfortunately, fractured permanent teeth are a common traumatic injury in adolescent children and often requires a simple bonding procedure, which is similar to having a cavity filled, except there is no decayed tooth structure to be removed.

We understand that often tooth color may be an aesthetic issue for adolescent patients and we offer safe and gentle bleaching to lighten the color of your child’s teeth. We encourage your teenage child or you to address any cosmetic concern you may have and will offer you a solution that meets your needs.

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Although stainless steel crowns have been around for decades due to their proven durability and effectiveness, recent technology in the field of pediatric dentistry has allowed us to offer esthetic white crowns for baby teeth that are just as durable and long-lasting, without compromising the beauty of your child’s smile with an all-metal crown. If esthetics is a primary concern for you, Dr. Loren or Dr. Natasha will determine if your child is a good candidate for this type of crown.

Behavior and Pain Management:

Dr. Larson and Dr. Buonocore are Board Certified Pediatric Dentists with many years of experience devoted to delivering dental care to children in the most compassionate and comfortable manner possible. Many children are fearful or nervous when they first go to the dentist or may have special needs that make receiving dental care especially difficult. Sometimes these fears are easily mitigated with routine strategies, but in some instances more advanced techniques are necessary. Part of pediatric dental training includes early childhood development and childhood psychology. Both doctors are well versed in the many behavior management techniques supported by the American Academy of Pediatric Dentistry. Please feel free to discuss any concerns or issues with the doctors. They encourage open communication between doctor, patient and parents.

Nitrous Oxide is commonly called laughing gas and is often recommended for children that need to undergo a dental procedure that may be uncomfortable or cause fear or anxiety. The purpose of Nitrous Oxide is to make it more comfortable for your child to receive the necessary dental care with less pain and/or anxiety. Nitrous oxide is classified as an analgesic because it reduces pain and for many procedures makes local anesthesia unnecessary. It is also an anxiolytic, which means your child will be in a pharmacologically induced state of consciousness where he/she is awake but has decreased anxiety to facilitate coping skills, retaining interactive ability. Nitrous Oxide helps to ease patient’s fears so as to help them relax during their visit, and to receive dental treatment in a comfortable and safe manner. It is typically delivered through a mask over the nose; nitrous oxide is mixed directly with oxygen and delivered as the patient breathes in and out regularly. The patient is usually asked to breathe normally through the nose, and as the gas begins to take effect, the child will become more relaxed and less nervous. It raises the pain threshold and may even make the time appear to pass quickly. Some normal sensations that a patient may feel may include tingling in the fingers, toes, cheeks, lips, tongue, head or cheek area; heaviness in the thighs and/or legs, followed by a lighter floating feeling; resonation in the voice; warm feeling throughout body, flushed cheeks; fits of uncontrollable laughter or giddiness; a lightweight or floating sensation with an accompanying “out of body” sensation; sluggishness in motion and slurring and/or repetition of words. Rarely a child may feel dizzy or nauseous. We do ask you not to give your child any food or drinks for two hours prior to any procedure scheduled requiring the use of laughing gas. Laughing gas enhances communication between your child and their doctor during dental procedures. Additionally, it reduces the gag reflex, which can interfere with effective dental treatment. All of these sensations and reactions are temporary and go away after 100% oxygen is delivered at the end of the procedure.

Nitrous Oxide is 100% safe to use during treatment and is eliminated from the body quickly after the gas is turned off. The child will remain awake during the entire procedure and will be able to interact and communicate with the pediatric dentist. After the procedure(s) are over, the nitrous oxide gas will be turned off and your child will be given oxygen for 3 to 5 minutes, which flushes the laughing gas and its effects out of your child’s system. There are no lingering effects.

Nitrous Oxide is perhaps the safest relaxant used in dentistry. It is well tolerated, having a rapid onset, and is reversible, can be adjusted in various concentrations and is non-allergenic. Absolutely no one is allergic to oxygen or Nitrogen, which are the only two ingredients in Nitrous Oxide. Your child remains fully conscious and maintains all natural reflexes when breathing the gases. He or she will be capable of responding to a question or request. You should inform our office regarding any respiratory condition that makes breathing through the nose difficult for your child. In a very small percentage of children Nitrous Oxide may not be effective, especially those children who have severe anxiety, nasal congestion or discomfort wearing a nasal mask. We will review your child’s medical history, level of anxiety, and treatment needs and inform you if nitrous oxide is recommended for your child.

Dr. Larson and Dr. Buonocore are Board Certified Pediatric Dentists that have devoted their entire practice to meeting the dental needs of children.

Chelsea Pediatric Dentistry wants your child’s dental visit to be a positive and comfortable experience for both of you. We are constantly implementing new technology to help us achieve that goal. In order to treat your child’s tooth without pain he/she needs tooth numbing/local anesthesia. Traditionally, local anesthesia was administered with a needle. The numbing done with the needle numbs the entire area around the tooth including the lips and gums. This kind of numbing is associated with an increased risk of post-operative trauma from lip/cheek biting. While there may be some procedures requiring traditional injections, the STA is available as an alternative either with or without the use of Nitrous Oxide. STA is Single Tooth Anesthesia. STA is a computerized sensor-controlled local anesthetic delivery system that anesthetizes only the tooth being treated via an intraligamentary “injection” that consists of gently sliding a small probe alongside the tooth in the small crevice between the tooth and the gums.

What are the benefits of the Wand/STA?

  • No need for the traditional dental syringe (“the shot”), thus reducing patient’s initial anxiety
  • Injection is much more comfortable and less painful for the patient due to precise control of anesthetic flow rate
  • Only the single tooth being worked on is anesthetized, thus decreasing post-operative numbness and the possibility of lip-biting
  • Quicker onset of anesthesia. No waiting period necessary to allow the numbness to take effect. Treatment begins immediately

Choosing the safest modality to manage the behavior of young, immature and sometimes frightened children, as well as those who may have physical or mental limitations, is a challenge unique to pediatric dentists. It requires an understanding of child psychology, pharmacology and child development as well as a healthy dose of patience, love and discipline. In our office, we offer a variety of behavior management techniques tailored to your child’s specific needs. Our goal is to treat your child in the safest, least invasive manner possible, as the use of any medication always carries with it some risk of an adverse reaction. We make every attempt to use our best judgment in determining which children need some form of sedation.

Our decision to sedate or not sedate a child ​is​ ​made solely with the best interest of the child in mind. ​​Please keep in mind that we do not choose a treatment modality based on what is most convenient for the doctors or the parents/guardians.​ ​Our goal is to facilitate a pleasant experience that does not cause your child a lifetime of fear​ful ​dental visits. As pediatric dentists, we ​strive to make the dental experience easy ​and pleasant ​for​ the child first, and then as easy as possible for ​the parents and ourselves.

The majority of the time when the non-pharmacological techniques are not successful, all that is needed is some laughing gas (Nitrous Oxide). This involves simply resting a scented mask​ over the child​’​s ​nose​. The child is not “put to sleep,” however they do usually feel somewhat “tingly,” and “ticklish.”​ Occasionally, but not always, the nitrous oxide will cause children to become very “giggly”​, earning its namesake.
Beyond the use of nitrous oxide/laughing gas, there are several other methods of conscious sedation that can be used. They may be administered either orally in the form of a drink, or as an injection. The details of these forms of sedation are best discussed with the Doctors, as there can be additional risks in administering them to a child.

​Anesthetic medications will allow your child to “sleep” through the procedure in a safe, controlled, and monitored setting, thus allowing Dr. Larson or Dr. Buonocore to provide the highest quality, comprehensive, and pain-free treatment in the most ​efficient manner available to your child. The treatment is completed efficiently and in one treatment session rather than multiple sessions. Children report no memory of receiving their dental or surgical care. While ​no doctor is able to offer risk-free​ sedation​, we do ​everything in our power to ensure the safest possible environment for your child’s dental treatment. Our mission is to provide your child anesthesia services with the highest standard of patient care and safety, while in the comfort, convenience and familiar surroundings of our pleasant and child-friendly dental office. ​ ​
​Please keep in mind that if one of our Doctors recommend sedation for your child’s dental treatment, it is only because we feel strongly that the risks of performing dentistry while your child is awake would outweigh the inherent risks of sedation. ​

PRE-SEDATION INSTRUCTIONS:

If you child has a cough, fever, runny nose, etc. in the​ days ​leading up to the appointment, please call our office, as we may need to reschedule. For ​their safety, we will not sedate ​a​​ sick child. Your child may not have anything to eat ​or drink ​the morning of the procedure. ​ ​Please arrive for your appointment at the requested time. ​For more detailed pre-sedation instructions, please consult with Dr. Boorin {insert hyperlink to Dr. Boorin’s profile here when you click on his name} directly.

POST-SEDATION INSTRUCTIONS:

We will give you a comprehensive sheet of post-operative instructions on the day of your child’s appointment.

Following the appointment, you will be brought back to your​ child​ as he/she is “waking up”​ ​and you will be asked to remain in our office for a​​ period of time as we ​continue to monitor him/her ​​until it is safe to send your child home. They may remain sleepy until later in the day or early evening​. ​ I​f you plan to drive to the appointment​, you should bring along another responsible person to help watch ​your child in the car on the way home. ​ ​Your child ​may also need supervision at home to help prevent any accidental falls. If your child should fall asleep, make sure they are lying on their side, with their chin away from their chest. If they should vomit, be sure they are awake or lying on their side.

Depending on the specific procedures performed, your child ​may​ receive local anesthesia​ during the sedation​. ​ ​Please remind them to avoid biting or playing with their lips and cheeks. They can​ unintentionally​ cause serious trauma to themselves​ while their mouth ​remains ​numb​ for a period of time following the procedure​.
Please encourage your child to drink fluids as soon as they express the desire to do so. Avoid solid foods until your child completely recovers.

Your child should not experience any significant pain after he/she awakens. You may give them Children’s Motrin or Tylenol

​as ​needed for any ​post-op ​discomfort. If the Tylenol or Motrin ​is not enough to manage their discomfort, please call our office. If your child should become ill, or any other problem should arise, please notify our office. If​ you try calling the office outside of normal business hours, an emergency number​ will be provided and you will be put in contact with either Dr. Larson or Dr. Buonocore directly.

For more information please view Martin R. Boorin, DMD