Hole in One

Child dentistry procedures tackle more than cavities

By Tracey Edgerly Meloni

Seven-year-old Maya doesn’t even have permanent teeth yet, but she has spent much of her life at the dentist. Born with a rare, lifelong condition that causes brittle bones and fragile teeth, Maya has experienced extractions, fillings, crowns, infections and fractures. She plays happily in the waiting room and looks forward to her reward sticker—and she is grinning.

This is not your mama’s childhood dentistry. Area dentists for kids are highly trained specialists, able to handle it all from the usual, like fillings, fluoride and impacted wisdom teeth, to conditions like Maya’s. From too many teeth to too few, cleft palates to facial anomalies, any need has a matching set of specialists.

Early Canine Impactions
Ashleigh Ferguson is active and bubbly, looking forward to her 12th birthday with a confident smile. “She gets many compliments about her teeth and how pretty they look,” says her mother, Tammie, of Lansdowne. But that might not have been the case without orthodontic intervention and a sound relationship with Dr. Rana Barakat, the Sterling-based orthodontist first consulted when Ashleigh was 8 years old. Early diagnosis revealed Ashleigh’s severely impacted upper canines, or “eyeteeth,” as well as a crossbite.

The American Association of Orthodontists recommends an initial orthodontic evaluation around age 7, when permanent first molars have erupted. Barakat determined that Ashleigh’s teeth “did not fit together properly, that she had severe crowding in her upper jaw, and she had impacted upper canines.” Ashleigh’s narrow smile and misaligned jaw presented problems, “and the upper permanent eyeteeth were positioned such that they would not erupt on their own.”

At the first consultation appointment, Barakat determined that it was too early for treatment, and recommended waiting for further dental development and growth. “A year later, I re-evaluated Ashleigh, and she was ready for treatment. Ashleigh’s dental development determined the timing of treatment, and hers was more advanced than her peers,” she adds.

“Dr. Barakat used X-rays, photos and models,” Ferguson says. “She used a computer-simulated program as a visual aid and explained the pros and cons of doing this treatment at a young age compared to waiting until Ashleigh was a teenager. Barakat made sure I understood every aspect of this treatment. I felt as if she was truly doing what was best for my daughter.”

Barakat’s office is not only state of the art, but also fun. Parents like the distraction of computer games in the reception area as much as kids, and Barakat’s exciting contests make for great rewards.

Barakat says Ashleigh’s treatment consists of two phases. Phase I lasted 18 months and concentrated on widening her upper jaw using a palatal expander, limited braces to manage her impacted upper teeth. “Once the expander process was complete, we referred Ashleigh for removal of her upper baby canines and exposure of her impacted upper permanent canines. This procedure lasted around 30 to 60 minutes, during which the impacted teeth were exposed, attachments were placed on the teeth, and the incision closed,” Barakat explains. “After healing, I began bringing both of her impacted canines into position, using the attachments. Once the teeth were visible, I changed the attachments to braces, and aligned the canines.”

After about 18 months of treatment, Ashleigh was given a retainer to wear at night “to maintain new tooth alignment, while the remainder of her permanent teeth erupt.” The outpatient exposure procedure was done under local anesthesia. “Some patients elect to be put to sleep or given a sedative,” Barakat says. “Healing from the procedure is about two to three days, during which the patient generally sticks to a softer diet and stays away from vigorous physical activity.”

To complete her treatment, Ashleigh will be required to go through Phase II in order to fine-tune her bite and get the final tooth alignment. “She is now in a position to have a much shorter time in full braces,” Barakat says.

Brittle Bones, Fragile Teeth
“Seven-year-old Maya Simbulan has Osteogenesis Imperfecta [OI], along with Dentinogenesis Imperfecta [DI],” says her mother, Jennifer. These are going to be “lifelong problems for Maya, and so we take care of her teeth with good dental care and hygiene.” Fairfax-based pediatric dentist Dr. Sherry Sharif was Jennifer’s choice.

“Dr. Sharif has a great staff, with gentle hands, happy faces and a kid-friendly office with TV and toys for distraction,” says Simbulan, who has a good understanding of Maya’s condition thanks to Sharif.

OI is called brittle bone or fragile bone disease. “Patients are prone to bone fractures. They have short stature, triangle-shaped faces and blue sclerae [whites of eyes],” Sharif explains. “They have hypermobile joints and vertebral collapse. Their teeth have yellow/translucent color. They may also have congenital heart defects.”

Maya’s treatment is ongoing, with regular recall visits. “Also, she develops dental abscesses due to her weak teeth and needs treatment such as extractions or stainless-steel crowns. She does not yet have any permanent teeth, but her primary teeth are yellow-amber/translucent color particular to DI Type I. Her permanent incisors should come in with normal length and contour,” Sharif shares.

Asked about the risks involved, Sharif says, “risks are very minimal if proper infection control protocol and minimally invasive technical procedures are adapted. General anesthesia nowadays administered by pediatric anesthesiologists at Fair Oaks Hospital is very safe and effective.” She adds that it provides peace of mind for the families of an apprehensive child.

Jennifer is satisfied. “Maya has dental visits every three months for checkup and fluoride treatment. She also has cleaning every six months. She has been on antibiotics on several occasions for abscesses and currently has one root fracture, which we are just observing for now.”

Teeth Extraction
Children and adolescents with special needs find a perfect fit with Dr. J. Daniel LaBriola of Fairfax Station. While not primarily a children’s dentist, the Northern Virginia oral/maxillofacial surgeon and his associates can put their unique talents to work in special circumstances. They are able to uncover teeth out of position for orthodontists to follow up, and they use case-specific anesthesia techniques for many types of special-needs patients.

Laurie Moore of Goldvein happily traveled some distance to take her autistic son, Chase, to LaBriola’s offices. “Chase is a gentle giant,” explains the proud mother. But the 18-year-old, standing 5-foot-9 and weighing some 240 pounds, needed just the right practitioner when it came time to remove his wisdom teeth.

“We had some pretty negative experiences before finding Dr. LaBriola,” she goes on to explain. “Right away, he knew just what to do, and to do it fast. The rapport was wonderful. He understands Chase’s needs and anxiety.”

Moore adds that LaBriola will be her pick to work with Chase again on anesthesia for any potential future dental needs.

“We like to have a consultation visit to get a feel for the needs of a child with a routine tooth removal,” says LaBriola, adding that knowing the child’s anxiety level helps determine how to proceed: “Local anesthesia, sedation with nitrous oxide, or is there a need for a general anesthetic.”

Consultation, however, isn’t always a possibility. In cases of emergencies, where the child is in severe pain or has an acute infection, “then we proceed, maybe starting with laughing gas.”

“Most children’s procedures are over in a matter of minutes—the treatment is short and sweet.”

LaBriola adds that dental risks in kids are notably different from those of adults. “They can get in trouble fast. An infection can become life-threatening quickly in a child.”

Risks of bleeding and post-op infection are also greater in children if proper precautions are not taken.
Further, “children have difficulty communicating their needs,” LaBriola notes, especially when a hospital day or night visit is involved. “We make sure they are properly hydrated, taking in calories, able to go to the bathroom, and have pain control” before releasing them, although usually the hospital stay is no more than a single night.

All agree that the best way a parent can ensure lifelong dental health for a child is to invest time in conducting the appropriate amount of research, find a dentist in your region with the right rapport, office and training for you and your child, and to start visits early.

Our Dental Experts

Rana Barakat, DDS
45745 Nokes Blvd., Dulles; 703-433-9330; www.barakatorthodontics.com
DDS, University of Tennessee 1994
Diplomate, American Board of Orthodontists
12 years in practice

Sherry Sharif, DDS
3700 Joseph Siewick Drive, Fairfax; 703-620-9122
DDS, Howard University 1993
Diplomate, American Board of Pediatric Dentistry
12+ years in practice

L. Daniel LaBriola, DDS
5619 Smoke Rise Lane, Fairfax Station; 703-978-7013
DDS, Georgetown University 1976
Diplomate, American Board of Oral and Maxillofacial Surgery
28+ years in practice

(November 2008)

Tags: child dentistry, Dentist, Health & Beauty