Services

Services & Technologies

Dr. Lori provides a variety of diagnostic, preventive, and restorative services. She takes a conservative and individualized approach to your child's dental care. Treatment recommendations are evidence-based, follow the standard of care for the specialty of Pediatric Dentistry, and are informed by over 35 years of experience treating children. There is not a "one size fits all" plan, even with the use of x-rays or fluoride. Please remember that children are not small adults, and recommendations for your child or adolescent may differ from the care you receive from your family dentist.


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Caries Risk Assessment

The use of fluoride, x-rays, and other dental treatments is based on each individual's history and clinical evaluation. Caries-risk Assessment Tool (CAT) is the professional standard for determining the risk for developing decay. Factors considered include;

  • special health care needs
  • salivary flow
  • use of a dental home
  • time lapsed since last cavity
  • presence of braces
  • dietary habits
  • fluoride exposure
  • visible plaque on front teeth
  • gingivitis
  • demineralizations
  • enamel defects
  • radiographic enamel caries
  • clinical judgment of the dentist

Dr. Lori will discuss your child's caries risk assessment with you at their next visit.

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Fluoride Treatments

Optimal levels of fluoride in a child's drinking water and dietary exposure to fluoride help the developing teeth form enamel that is much more resistant to tooth decay, without risk of fluorosis. Most children in mid-Missouri have optimally fluoridated water. Children are also exposed to systemic fluoride in ready to use infant formula and other dietary sources, therefore Dr. Lori rarely needs to prescribe daily fluoride supplements for her patients. If you use well water, ask Dr. Lori how you can have your drinking water tested for fluoride content. Prenatal fluoride supplements are never necessary for pregnant women.

The use of fluoride toothpaste twice daily is a primary preventive strategy in children. Significant anti-caries benefit is obtained from the use of topical fluorides, like toothpaste, even when you live in an area with optimal water fluoridation. Parents should dispense the proper amount of fluoride toothpaste for children under 6 years of age as illustrated.

Additional at-home topical fluorides like rinses or brush-on gels may be recommended by Dr. Lori for school-aged children at high risk for tooth decay.

Topical fluoride applied at the dentist's office is based on a child's caries risk assessment. Children at low risk for caries will benefit from a professionally applied topical fluoride once or twice a year. Children with moderate risk of caries should receive a fluoride treatment at least every 6 months; those at high risk should receive a fluoride varnish treatment every 3 - 6 months. Application of fluoride varnish is safe and may also be effective for infants and toddlers at risk for Early Childhood Caries and children wearing braces.

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This 7 year old still needs daily supervision and assistance with brushing and flossing. Plaque stained pink has been present for 24-48 hours but blue stained plaque has been present for days.

Oral Hygiene & Nutrition

Caries is a common bacterial disease caused by plaque-induced acid demineralization of the tooth. There are risk factors and protective factors, and keeping them in balance is what prevents cavities in your children's teeth. Here are some age-appropriate tips from Dr. Lori:

INFANTS

  • If your infant falls asleep while feeding, wipe their teeth before laying them in bed.
  • Start brushing your child's teeth twice a day when they start to erupt.
  • Infants should not be put to bed with a bottle.
  • Ad libitum breast-feeding should be avoided after the first teeth erupt.
  • Encourage your child to drink from a cup as they approach their 1st birthday.
  • Schedule your child for a Well Baby Dental Visit by their 1st birthday.

AGES 1-6

  • Parents should continue to assist their children with tooth brushing.
  • For children under age 3, a smear of fluoride toothpaste is appropriate.
  • Parents should dispense a "pea-sized" amount of fluoride toothpaste after age 3.
  • Wean your baby from the bottle by 12-14 months of age.
  • Floss your child's teeth once a day, as instructed by Dr. Lori.
  • Avoid letting your child use a sippy cup to drink juice, milk, soda, or other beverages that contain fermentable carbohydrates, especially between meals.
  • Help your child develop healthy snacking habits by offering foods that are nutritious.
  • Avoid allowing your child "nibble and sip" throughout the day.

* Remember: The American Academy of Pediatrics recommends that children ages 1-6 should drink no more than 4-6 ounces of juice a day from a cup as part of a meal or snack.

SCHOOL-AGED CHILDREN

  • Parents should assure that their child brushes twice daily with a fluoride toothpaste.
  • Look for plaque along the gum line of the front teeth to verify effectiveness of brushing.
  • Parents should continue to supervise and assist as needed with daily brushing and flossing.
  • Occasional sweets and treats are best consumed after a healthy meal.
  • The American Academy of Pediatrics promotes water, not sports or energy drinks, as the principal source of hydration for children and adolescents. Click here for more information.
  • Active children burn lots of calories and usually eat 3 meals and 2-3 snacks a day. Help them make healthy choices and avoid "empty" calories. Discourage children from "sipping and grazing" because frequency of exposure to sugars and fermentable carbohydrates increases the risk of caries.

TEENS

  • Remind your teen to brush thoroughly at least twice a day with a fluoride toothpaste.
  • If your teen frequently "forgets to brush" or is "too tired", help them pick a time of day that can work better for them, like after school or after dinner.
  • Remind your child to floss daily.
  • Make healthy snacks available and discourage frequent "sipping and nibbling".
  • Discourage your teen from drinking soda, sports drinks, and other acidic, sugary beverages.
  • Remember that diet sodas are acidic and may increase the risk of enamel erosion.
  • Energy drinks are popular with teens, but contain sugar and caffeine or other stimulants. Some contain more than 500mg of caffeine which is like drinking 14 cans of cola!
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Sealants

Sealants are used to fill in narrow grooves in a tooth that cannot be adequately cleaned by brushing. Fine grooves or pits in primary and permanent teeth accumulate plaque, not because the person doesn't brush, but because these pits and grooves are too narrow to allow even one bristle into them. These will develop cavities over time, and you don't want that.

9 out of 10 cavities in school-aged children occur in pits and fissures and that's why Dr. Lori will recommend sealants for teeth she considers at risk for this type of tooth decay.

Applying sealants is easy. After the tooth is cleaned, a special gel is placed on the chewing surface for a few seconds. The tooth is then washed and dried. Then, the sealant is painted on the tooth. The dentist or dental assistant will shine a light on the tooth to help harden the sealant and form a protective shield.

At your child's regular dental exam, their sealants are evaluated and maintained or replaced as needed. With appropriate follow up care, sealants may protect against most chewing surface cavities.

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Monitoring Growth & Occlusion

Evaluating your child's growth and occlusion (bite) is an important part of each dental visit with Dr. Lori. As a toddler the focus will be on eruption of the baby teeth and oral habits like thumb sucking or pacifier use. Some growth concerns like crowding and crossbite can be detected before permanent teeth erupt and Dr. Lori can monitor if the condition is improving or worsening as the child grows.

Problems with eruption of the first permanent teeth can be detected and treated, like the presence of an extra incisor. Early intervention can help a child enjoy a beautiful smile and possibly prevent the need for full braces. Proper eruption of permanent teeth can also be facilitated by the simple removal of a baby tooth that is not shedding properly.

Even if your child is at low risk for cavities, it is important for Dr. Lori to examine them on a regular basis to monitor eruption and intercept problems early or help you plan for future orthodontic correction.

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Restorations / Fillings

 
  Treatment   Conditions   Pro's & Con's  
   
Preventative Resins   Tiny cavities, enamel only   Look natural, great preventive measure, smaller investment  
   
             
  Tooth-colored fillings; composite resin, glass ionomer, resin ionomer   Smaller cavities   Look natural, work best in low-stress areas, less affordable than amalgams  
   
             
  Amalgam fillings   Cavities   Very durable, less natural-looking, more affordable than tooth-colored fillings  
   
             
  Stainless steel crowns   Severe decay, molar tooth with fracture, developmental defect, pulpotomy   Very durable, less natural-looking, more affordable than tooth-colored crowns  
   
             
  Tooth-colored crowns   Severe decay, usually front tooth with fracture, developmental defect, or pulpotomy   Look natural, durable on front tooth but less on molars, less affordable than stainless steel crowns  
         

Composite (resin)

Composite is a mixture of acrylic resin and powdered glass-like particles that produce a tooth-colored filling. This type of material may be self-hardening or may be hardened by exposure to blue light. Sometimes it is used to replace a portion of a broken or chipped tooth.

Advantages of composite:

  • Color and shading can be matched to the existing tooth
  • Composite is a relatively strong material, providing good durability in small to mid sized restorations that need to withstand moderate chewing pressure
  • Composite may generally be used on either front or back teeth
  • Moderately resistant to breakage
  • Often permits preservation of as much of the tooth as possible
  • Low risk of leakage if bonded only to enamel
  • Does not corrode
  • Generally holds up well to biting force
  • Moderately resistant to further decay, new decay is easy to find
  • Frequency of repair or replacement is low to moderate

Disadvantages of composite:

  • This type of filling can break and wear out more easily than metal fillings, especially in areas of heavy biting force. Therefore, composite fillings may need to be replaced more often than silver fillings.
  • Compared to amalgams, composites are sometimes difficult and time-consuming to place.
  • They can not be used in all situations.
  • Composite generally is more expensive than amalgam.
  • May wear faster than natural dental enamel
  • May leak over time when bonded beneath the layer of enamel

Glass Ionomer

Glass ionomers are tooth-colored materials made of a mixture of acrylic acids with fine glass powders that are used to fill cavities and sometimes seal teeth. They are versatile and are used as temporary fillings and ITR (Interim Therapeutic Restorations). Glass ionomers also are used to cement dental crowns and as a cavity lining material to protect the pulp.

Advantages of glass ionomer:

  • Tooth-colored so the filling looks more natural
  • Can act as a fluoride reservoir that may help prevent further decay
  • Minimal amount of tooth structure removed
  • Can be used as a temporary or under other filling materials to protect the pulp

Disadvantages of glass ionomer:

  • Low resistance to fracture
  • Moderate cost, similar to composite (costs more than amalgam)
  • As it ages, this material may become rough and plaque can build up
  • Can be dislodged

Resin Ionomer

Resin ionomers are also made from glass filler with acrylic acids and acrylic resin. They are a hybrid of the properties of resin and glass ionomer and they harden with exposure to blue light. Resin ionomers are most commonly used in fillings on non-chewing surfaces and fillings in primary (baby) teeth.

Advantages of resin ionomers:

  • Tooth-colored, more translucent than glass ionomer
  • Can contain fluoride that may help prevent further decay
  • Minimal amount of tooth structure removed to place it
  • Adheres well to primary (baby) teeth
  • May last longer than glass ionomer but is not as durable as composite

Disadvantages of resin ionomer;

  • Limited use because it is not recommended for biting surfaces in adult teeth
  • Moderate cost, similar to composite (more than amalgam)
  • Wears faster than composite and amalgam

Amalgam

The word "amalgam" when referring to dental fillings means a mixture of two or more metals in which mercury is a component. Dental amalgams have commonly been called "silver fillings" because of their silver color when they are first placed. Today, amalgam is used most commonly in the back teeth. It is one of the oldest filling materials and has been used (and improved) for more than 150 years. Dental amalgam is the most thoroughly researched and tested filling material.

Advantages of amalgams:

  • Strong, durable and stands up to biting force
  • Can be placed in one visit
  • Normally the least expensive filling material
  • Self-sealing with minimal-to-no shrinkage and it resists leakage (leakage occurs when a filling does not completely seal, permitting food and bacteria to "leak in" and promote new decay behind or beneath the filling)
  • Resistance to further decay is high
  • Frequency of repair and replacement is low
  • Amalgam is the only material that can be used in a wet environment.

Disadvantages of amalgam:

  • While agencies like the U.S. Food and Drug Administration (FDA), the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) have not found evidence of harm from dental amalgam, there are some individuals and groups who have raised concerns about the very low levels of mercury vapor released by amalgam
  • Amalgam scrap (waste left over after repairing a cavity) contains mercury and requires special handling to protect the environment
  • Amalgam can darken over time as it corrodes. This does not affect the function of the filling, but many people find it less attractive than tooth colored materials
  • Placement of amalgam requires removal of some healthy tooth.

Stainless Steel Crowns

Stainless steel crowns are prefabricated crown forms that are adapted to individual teeth and cemented with a biocompatible luting agent, frequently glass ionomer. SSCs are indicated for the restoration of primary and permanent teeth with caries, cervical decalcification, and developmental defects, when failure of other available materials is likely. In primary (baby) teeth they are also used when the tooth has been treated with a pulpotomy, used as part of a space maintainer, and in children with high caries risk. When esthetics is more important than strength, there are SSCs with tooth-colored veneers for use in restoring primary incisors.

Advantages of stainless steel crowns;

  • Durable and can be used in areas of poor moisture control
  • More favorable success rate in restoring multiple-surface tooth decay in preschool aged patients than other filling materials
  • SSCs will shed with the baby tooth

Disadvantages of stainless steel crowns

  • The facing on tooth-colored veneered SSCs can fracture or wear SSCs used to restore permanent teeth in children are considered long term temporaries that will need to be replaced with gold or porcelain crowns as an adult.

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Extractions

Primary teeth are important for smiling, chewing, speaking, and guiding permanent teeth into their proper place. Permanent teeth are meant to last a lifetime with proper care. Although pediatric dentists will use every measure to prevent tooth loss, there are still some occasions when a tooth may need to be extracted. A tooth may need to be extracted if the following occurs;

  • Severe decay
  • Infection or abscess
  • Orthodontic correction
  • Primary teeth remaining when the permanent tooth is erupting
  • Fractured teeth or roots
  • Impacted teeth

After careful examination Dr. Lori may advise to have a tooth extracted. Before a tooth is removed, a new x-ray may be taken to understand the shape and position of the tooth and surrounding bone. Some circumstances, including removal of wisdom teeth, will be referred to a specialist called an oral surgeon.

Dr. Lori will help you prepare your child to have a tooth removed to avoid unnecessary anxiety.

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Dental Trauma

Keep Dr. Lori's office phone number handy

 573-446-6868

or call Boone Hospital Center for after hours emergencies.

 573-815-8000

Broken Tooth:

Rinse with warm water to clean the area, give an analgesic like Motrin or Tylenol, and use a cold compress on the cheek or lips in the area of the injury to decrease swelling. If the tooth is also loose or displaced contact Dr. Lori for advice. If the chip is small and your child is not uncomfortable still Call Dr. Lori within 12-24 hours of the injury.

Avulsed (knocked-out) Tooth:

If your child avulses a baby tooth, it should not be re-implanted because the permanent tooth bud may be further injured. Find the tooth if possible and contact Dr. Lori within 24 hour of the injury.

If your child has knocked-out a permanent tooth, time is of the essence. It is best for the tooth to be replaced within 30 minutes, so

  1. Take a deep breath, stay calm, and find the tooth.
  2. Hold the tooth by the shiny enamel crown and rinse the root in water if it is dirty.
  3. DO NOT SCRUB IT OR REMOVE ANY OF THE TISSUE ATTACHED TO THE
    ROOT! This tissue is critical to healing and Dr. Lori will be prescribing an antibiotic.
  4. If possible, insert the tooth back into the socket. Your child may be upset but it does not hurt to put the tooth back - it is exactly what Dr. Lori would do if she was there.
  5. If you cannot re-implant the tooth, place it in milk and bring it to the dentist or to the emergency room. If you can't find milk, use water.

Tongue or Lip Wounds:

Clean the area gently and apply cold compresses to reduce any swelling. If the bleeding can't be controlled, go to an urgent care clinic or a hospital emergency room.

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Digital X-Rays

Radiographs allow Dr. Lori to see hidden abnormalities, like tooth decay, infections and signs of gum disease, including changes in the bone and ligaments holding teeth in place. It also allows her to detect developmental abnormalities and some types of tumors. Finding and treating dental problems at an early stage can save time, money and unnecessary discomfort. The dentist can detect problems that otherwise would not be seen during a thorough clinical examination.

How often X-rays (radiographs) should be taken depends on your child's present oral health, age, risk for disease, and any signs and symptoms of oral disease. Children require X-rays more often than adults because their teeth and jaws are still developing. Also their teeth are more likely to be affected by tooth decay than those of adults. Dr. Lori will review your child's history, examine the mouth and then decide whether radiographs are needed.

Most people are exposed to 6.2 millisieverts (mSv) per year, about half from natural sources. A dental X-ray dose is approximately 0.005 mSv which is very low. Dr. Lori wants you to know that a number of steps are taken to ensure that children are exposed to a minimum of radiation when dental radiographs are needed. This radiation safety principle is ALARA ( As Low As Reasonably Achievable) and is achieved by use of;

  • digital sensors
  • protective patient shield with thyroid collar
  • equipment that is regularly inspected
  • equipment where exposure can be adjusted to patient size
  • equipment that provides a small, collimated x-ray beam
  • technique that minimizes the number of images needed for diagnosis
  • digital image transfer from other dentists when available
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Athletic Mouth Guards

Boil and bite mouth protectors are inexpensive and can be bought at most sporting good and department stores. The "boil and bite" mouth guard is made from thermoplastic material. It is placed in hot water to soften, then placed in the mouth and shaped around the teeth using finger and tongue pressure. They are somewhat bulky and make breathing and talking difficult for some people.

Custom-fitted mouth guards are individually designed and made in a dental office. First, Dr. Lori will make an impression of your teeth and a mouth guard is then molded over the model using a special material. A custom-made mouth guard is more expensive than the other types and it provides the most comfort and the best fit. Your child's teeth are best protected by the mouth guard they will wear for recreation, practice, and games.

Here's how to take good care of your mouthguard:

  • After each use, rinse with water or an antiseptic mouthwash. You can clean your
    mouthguard with toothpaste and a toothbrush too.
  • When not in use, place your mouthguard in a firm, perforated container.
  • Avoid exposing your mouthguard to high temperatures, like direct sunlight or on the dashboard of the car.
  • Examine your mouthguard for tears and holes. A mouthguard that's torn can irritate your mouth and lessen the amount of protection it provides.
  • Bring your mouthguard to your regular dental checkups so Dr. Lori can make sure it's still in good condition.
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Space Maintainers

A baby tooth usually is lost when the permanent tooth underneath it begins to grow, pushes it out, and takes its place. Unfortunately, some children lose a baby tooth too early due to trauma or tooth decay. In some situations of early tooth loss, Dr. Lori may recommend a space maintainer to prevent space loss or help guide a permanent tooth into a favorable position.

Primary or baby molars are normally maintained until 10 to 12 years old. If they are lost early, the teeth beside them can tip or drift into the empty space needed by the permanent bicuspids resulting is crowded and crooked teeth.

There are several types of space maintainers and they are custom fit to a child's mouth. Most children adjust to them within the first few days of wear and most are luted into place so they cannot be removed or lost. It is more affordable and easier for a child to keep teeth in their normal position with a space maintainer than to move them back in place with orthodontic treatment.

Lingual Arch   Nance Appliance
 
Band & Loop   Crown Loop.
 

When caring for your child's space maintainer;

  • Avoid sticky sweets and chewing gum
  • Don't tug or play with the appliance
  • Help your child keep it clean with normal brushing and flossing
  • Keep your regular appointments with Dr. Lori
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Nitrous Oxide Analgesia

"Happy Air" is a blend of two gases - oxygen and nitrous oxide. It has a pleasant aroma and helps most people experience a sense of well-being and relaxation. This is especially helpful when Dr. Lori needs to give a local anesthetic (numbing medicine) to "make a tooth go to sleep".

Perhaps the safest and mildest sedative in dentistry, nitrous oxide/oxygen can make long appointments easier and reduce anxiety and gagging. The child remains fully conscious during treatment and recovery is rapid and complete after breathing oxygen for a few minutes.

If a child is worried by the sights, sounds or sensations of dental treatment, they may respond more positively with the use of nitrous oxide/oxygen. Nitrous oxide/oxygen is a mild analgesic and anxiolytic and may not be effective in children who cannot tolerate the small nasal mask or those who are extremely fearful or very young. Dr. Lori will discuss other options if nitrous oxide/oxygen is not the best method to help you child accept treatment comfortably.

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Local Anesthesia

If you are concerned about how your child will accept "getting numb" here are some of the things other parents have said to help prepare their children;

  • "Dr. Lori is going to rub your gums with a bubblegum or fruit flavored Q-tip before your tooth goes to sleep."
  • "I've had a sleepy(numb) tooth, and I know you'll be fine when Dr. Lori makes your tooth sleepy(numb). It feels silly."
  • "Dr. Lori said that you can have a popsicle or ice cream to help you sleepy teeth wake up."
  • "Dr. Lori or her helper will explain everything you need to do to be comfortable."
  • "Dr. Lori never made one of my teeth sleepy, but I know she will answer your questions when we go for your filling next week. "
  • "Remember Dr. Lori's helper said that you can use the happy air to help your tooth go to sleep. I've used the happy air at my dentist's office and I think you'll like it."

Please avoid phrasing things in a negative way because most children aren't reassured when told, "The shot won't hurt." or "The shot is not painful." - all they hear are the words hurt, shot, and painful. By keeping your explanations simple and positive you can help Dr. Lori make it as easy and comfortable as possible for your child.

Dr. Lori also uses Milestone Scientific's STA Single Tooth Anesthesia System® unit when possible. It combines state-of-the-art computer-controlled injection technology with the dentist's expertise to achieve more precise injections and enhanced patient comfort.

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Interim Therapeutic Restorations (ITR)

Sometimes the placement of a traditional dental filling is not feasible and will need to be postponed. Interim Therapeutic Restorations are sometimes indicated for very young children, uncooperative patients, or patients with special health concerns. Dr. Lori doesn’t recommend ITR if the decay is deep and extensive throughout the mouth or if the patient has a toothache or abscess. These are the steps followed in the placement of most Interim Therapeutic Restorations;

  • The child sits in the dental chair and a parent sits near their child and Dr Lori.
  • We explain what will happen in simple terms.
  • The tooth does not need to be numbed.
  • Nitrous oxide and oxygen analgesia is seldom used.
  • Dr. Lori gently places a cotton roll next to the tooth.
  • Decay is removed with a hand instrument or small, slow speed rotary instrument.
  • The tooth is rinsed and wiped dry with a gauze square.
  • The tooth is restored with an adhesive restorative material, usually glass ionomer.

Most children will need to have the ITR replaced with a regular filling or stainless steel crown in 6 to 18 months. Think of an ITR as an effective “stop gap measure” that slows the decay process, giving us a bit more time to gain the patient’s trust and cooperation for a final filling. Success depends on good oral hygiene and dietary habits. It is important to return for follow-up care recommended by Dr. Lori and her staff.

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Silver Diamine Fluoride (SDF)

Selective application of silver diamine fluoride is a non-invasive procedure for management of decay or dentinal hypersensitivity. It is especially useful for very young children or fearful patients with small cavities. Dr. Lori is pleased that this medicament, which has been used successfully in other countries for decades, is now FDA approved and available in the United States. SDF 38% is more effective than other fluoride agents in interrupting the decay process and relieving dentinal sensitivity. Several applications of SDF 38% can halt the caries process by killing bacteria in the cavity and hardening softened dentin. It can help Dr. Lori manage decay until your child is ready to accept numbing, decay removal, and a traditional filling. ADA, Silver Diamine Fluoride