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Children appreciate having a parent present during care. We encourage a parent's presence for all appointments.

Complete Oral Health Examination, Digital X-Rays, Customized Re-mineralization Therapy, Microabrasion / MI Paste Therapy, Sealants, Appliance Therapy, Professional Dental Cleaning, Restorative Care, Toothprints ID Impressions, Sedation Dentistry, General Anesthesia Dentistry In-Hospital and In-Office, Caries Risk Assessment Testing, Oral Hygiene Instructions and Demonstrations, Root Canal Therapy to Primary Teeth, Professional Tooth Whitening, Athletic Mouth Guard Fabrication, Growing Up Cavity Free-Nutrition and Prevention counseling, Oral cancer screening, 24/7 Emergency Service and Care, Private Consultations.

Knee-to-Knee Position

servicesA safe and effective technique to safely provide an exam and care to infants, toddlers or children with severe anxiety.

  • You will sit across from Dr. Gunsaulis, or a member of her Team
  • You will sit facing each other with knees touching
  • Your child will sit on your lap facing you, tummy-to-tummy
  • Your child's legs will straddle your waist so that your elbows, or the sides of your arms, can be used to secure your child's legs safely against your side
  • You will lay your child's head back onto the dental providers lap
  • Dr. Gunsaulis will hold and support your child's head so that you are free to hold your child's hands

If you feel that you may be physically or mentally uncomfortable or unable to complete this technique, please tell us immediately. If this is the case, we will ask you if you would be happy reserving an appointment for an adult family member or friend whom you trust and who can comfortably help us provide care for your child using the knee-to-knee position.

We Recommend the Knee-to-Knee Position

Completing our patient's preventative care is very important to your child's health.

Regardless of our patient's age or cooperation, as long as preventive care can be provided safely with the assistance of a parent, or a parent's elective representative, it should be provided. Completing preventive services sends a positive message to our young patients. Patients allowed to complete preventive care with this encouraging assistance realize that it is not painful or scary.

Not providing preventive care to an uncooperative child rewards that child for behavior meant to influence us from providing necessary care, not to mention confirming the child's suspicions that the exam must be frightening and unnecessary.

Dr. Gunsaulis strongly believes that not providing preventive care is analogous to allowing a child to ride in a vehicle without a safety seat or belt. This is why Dr. Gunsaulis believes that no exceptions can be given when it comes to ensuring a healthy child.

*The above proprietary information of Molly Gunsaulis, DDS Dentistry for Children, PS may be copied if credit is given to Dr. Molly Gunsaulis as the source. Thank you.

Dental Surgery

services-02.jpgNo doubt about it, getting an operation can be stressful for kids and adults alike. If your child is scheduled for surgery, you may have questions or concerns about anesthesia, in particular. The thought of your child being unconscious or temporarily losing sensation can be downright unnerving, whether your little one is 7 months or 17 years old.

From a minor routine dental procedure to a more serious surgery in which your child will be "deeply sedated," knowing the basics about anesthesia may help answer your questions and ease some concerns — both yours and your child's.

About Anesthesia

Basically, anesthesia is the use of medicine to prevent the feeling of pain or sensation during surgery or other procedures that might be painful (such as getting stitches or having a wart removed). Given as an injection or through inhaled gases or vapors, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

In today's hospitals and dental offices, highly trained professionals use a wide variety of safe, modern medications and extremely capable monitoring technology. An anesthesiologist is a doctor who specializes in giving and managing anesthetics — the medications that numb an area of the body or help your child fall and stay asleep.

In addition to administering anesthesia medications before the surgery, the anesthesiologist will:

  • monitor your child's major bodily functions (such as breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels) during surgery
  • address any problems that might arise during surgery
  • manage any pain your child may have after surgery
  • keep your child as comfortable as possible before, during, and after surgery

Parents' Concerns

When your child is having any kind of procedure or dental surgery, it's understandable to be a little uneasy. You probably have plenty of questions about everything — from how the anesthesia is given, to what your child will experience, to where you're allowed to be.

What happens will, of course, depend on the type of procedure your child is getting and the kind of anesthesia that will be used, either:

  • general — in which your child would be "deeply sedated"
  • local — when one small part of the body is numbed

To ease your mind and feel more informed, here's a quick look at what may happen before, during, and after on the day of your child's procedure at a hospital or in our office.

Although you may be able to talk to the anesthesiologist a day or two prior to the operation, you may not meet until that day. Either way, the anesthesiologist will go over your child's medical history and information thoroughly, so that he or she can give the right amount of anesthetic medications tailored specifically to your child's individual needs.

The anesthesiologist may also order additional tests (such as X-rays, blood or laboratory tests) to help figure out the best possible personalized anesthetic plan for your child.

In addition to doing a physical examination of your child's airways, heart, and lungs, the anesthesiologist will also want to go over your child's medical history, which will include asking about:

  • your child's current and past health
  • your family's health
  • any medications, supplements, or herbal remedies your child is taking (consider bringing a list of exactly what your child takes, detailing how much and how often)
  • any previous reactions your child or any blood relative has had to anesthesia
  • any allergies (especially to foods, medications, or latex) your child may have
  • whether your child smokes, drinks alcohol, or takes recreational drugs (this usually applies to older teenagers)

The anesthesiologist and/or Dr. Gunsaulis will also let you know whether your child can eat or drink before surgery. It's important to make sure that your child doesn't eat anything prior to surgery (usually nothing after midnight the day before the operation). You'll get specific instructions based on your child's age, medical condition, and the time of day of the procedure.

Why is eating before surgery an issue? The body normally has reflexes that prevent food from being aspirated (or inhaled) into the lungs when it's swallowed or regurgitated (thrown up). Anesthetic medications can suspend these reflexes, which could cause food to become inhaled into the lungs if there is vomiting or regurgitation under anesthesia. Sometimes, though, the anesthesiologist will say it's OK to drink clear liquids or take specific medications a few hours before surgery.

To ensure your child's safety during the surgery, it's extremely important to answer all of the anesthesiologist's questions as honestly and thoroughly as possible. Things that may seem harmless could interact with or affect the anesthesia and how your child reacts to it.

General Anesthesia

The goal of general anesthesia is to make and keep a young dental patient completely unconscious, deeply sedated, during the operation, with no awareness or memory of the surgery. General anesthesia is started by inhaling gases by breathing into a mask and after the child is unconscious, general anesthesia can be given through an IV (which requires a needle stick into a vein, usually in the arm). In our office we like parents to escort their child to our treatment room and remain until your child is deeply sedated. In the hospital, parents are not allowed in the operating room.

If your child is having general anesthesia, the anesthesiologist will be there before, during, and after the operation to monitor the anesthetic medications and ensure your child is constantly receiving the right dose. With general anesthesia, the anesthesiologist uses a combination of various medications to:

  • relieve anxiety
  • keep your child asleep
  • minimize pain during surgery and relieve pain afterward (using drugs called analgesics)
  • relax the muscles, which helps to keep your child still
  • block out the memory of the surgery

After surgery, the anesthesiologist reverses the anesthesia process to help your child "wake up." It usually takes about 45 minutes to an hour for children to recover completely from general anesthesia. This recovery period is monitored by specially trained nurses either in the post-anesthesia care unit of the hospital or the recovery room in-office. During recovery, your child is still under the care of the anesthesiologist.

Tooth Decay

Tooth decay is the most common childhood disease in America. Tooth decay is the breakdown of the outer most layers of a tooth leading to the formation of a cavity. It starts as a white spot on a tooth and can become a large dark cavity in only a matter of months. Once these layers have been removed by this destructive process, your child is more likely to experience pain. Tooth decay is a bacterial infection and while it originally starts in a tooth it can and will spread if left untreated. How far the infection ultimately spreads is related to many factors. Some tooth infections can cause swelling of the immediate area and others do not. The most serious infections cause facial swelling preventing a child from breathing. In these cases emergency procedures have to be taken to insure a child's airway remains open, such as an emergency tracheotomy. Dental infections can become septic and travel through the blood stream and infect major organs. A dental infection, like any infection, must be taken seriously, especially when bacteria have become more resistant to antibiotics.

Stainless Steel Crowns and Root Canal Therapy

Stainless Steel Crowns are recommended for back teeth having three or more surfaces of decay. Teeth in the back of the mouth are subjected to higher forces of chewing than front teeth. When these teeth require a long lasting restoration a stainless steel crown is the optimal choice. Stainless steel crowns are silver in appearance. They require brushing twice daily and daily flossing in order to maintain the health of the surrounding gum tissue and prevent gum swelling.

A baby tooth root canal consists of removing the infected soft tissue at the center of the tooth and replacing it with a material which will allow the baby tooth to function and exfoliate naturally. Baby tooth root canals are more accurately referred to as pulpectomies or pulpotomies, depending on the amount of soft tissue removal. Root canals are usually very successful but infection can still occur, so it is very important to maintain regular preventive re-care appointments.

When Dr. Gunsaulis recommends a stainless steel crown and a baby tooth root canal, she does so by evaluating the existing tooth structure present in the mouth and by studying the x-rays. However, since x-rays are only two dimensional, she prepares parents for the worst by explaining that there is always a small chance that the tooth will require removal, called an extraction. An extraction becomes necessary if, during treatment, the tooth is found to be clinically unrestorable. If an extraction becomes necessary on a back tooth, Dr. Gunsaulis may discuss a space maintainer in order to preserve the space needed for the permanent tooth developing under the baby tooth.

Extractions and Space Maintainers

An extraction is recommended for teeth which have a poor prognosis and/or are not restorable. If a back baby tooth is extracted the teeth behind it will start to tip into the space it use to occupy. The permanent tooth developing under the gums will not have room to grow into a child's mouth if this is allowed to happen. Space maintainers maintain space only and do not prevent future orthodontic needs. Space maintainers are difficult to clean and require a diet without sticky, chewy or gummy candies. Space maintainers can break and therefore it is important to contact us immediately if this occurs.

White Crowns / Esthetic Stainless Steel Crowns

Esthetic stainless steel crowns are recommended for front teeth having three or more surfaces of decay. Teeth in the front of the mouth are not subjected to high chewing pressures and therefore are ideal for the placement of natural looking, white porcelain veneered stainless steel crowns. They require brushing twice daily and daily flossing in order to maintain the health of the surrounding gum tissue and prevent gum swelling. Although infrequent, porcelain can and sometimes does wear down or fracture leaving some of the stainless steel crown visible when a child smiles. If this should happen it is important to know that Dr. Gunsaulis will not replace a crown for this reason alone and restoring the porcelain is not possible.

ICON

In order to stop the progression of tooth decay we offer ICON, a filling delivered via a unique paint-on technique. ICON is simple and painless for the patient and gentle on the tooth just like a traditional sealant but with the advantage that it soaks into small cavities or areas that are starting to become cavities. ICON allows dentists to offer another tool against tooth decay.

When preventive products like fluoride are not enough; we can now offer ICON to stop the cavity progression in the early stages, instead of waiting until a filling or another restorative material is required.

White Fillings

Our practice places white fillings because they are durable, require less removal of healthy tooth than do traditional silver fillings, and they look much nicer. White fillings are our ideal filling material; however, because of the expense of this material, some insurance companies will only pay the amount of a silver filling. Dr. Gunsaulis will only place silver fillings at the request of a parent who understands that silver fillings are not our ideal treatment.

Sealants

Sealants are placed to help prevent tooth decay from starting in the deep pits and groves found on the biting surface of back teeth. Sealants last between 1-3 years and need to be replaced once they have worn off. Sealants do not require anesthesia but must be placed on dry teeth, so a child must be able to cooperate in order to place sealants.

Nitrous Oxide and Oxygen

Nitrous oxide and oxygen, N2O-02, is a blend of these two gases. It is delivered via a snug fitting nasal hood and uptake occurs through the lungs. At the end of dental treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects. Your child will smell a sweet, pleasant aroma and experience a sense of well-being and relaxation. Nitrous oxide and oxygen is used to help reduce or eliminate pain and a gag reflex. If your child is worried by the sights, sounds, or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide and oxygen.

Frenectomy

In the upper jaw a frenum is the tissue connecting the upper lip to the roof of the mouth and in the lower jaw it is the tissue connecting the tip of the tongue, or the lip, to the gums. A frenum in children, although a common finding, is often a concern. Treatment is necessary only when the frenum creates a traumatic force on the gums, or causes a large space between the upper front two teeth to remain after age eleven, or it interferes with feeding and/or speaking.

Options and Alternatives to Dental Treatment

Parents have many options and alternatives to dental treatment, including doing no treatment. Please do not hesitate to consult with Dr. Gunsaulis and her Team at any time. We are always open to your questions or concerns.

Growing Up Cavity-Free

services-03.jpgIn many countries, tooth decay is the second most common disease, with only the cold more common. Studies have linked poor oral health in children to poor performance in school, poor social relationships and less success later in life. But whether you're six or sixty, with today's technology and advances in dental medicine, it's easier than ever before to prevent cavities and gum disease.

To help your kids grow up cavity-free, here are a few tips:

  • Don't make the mistake of thinking baby teeth don't need as much care as permanent ones. Even though they're eventually lost, they do an important job of holding a place in your child's mouth for the permanent teeth, not to mention, helping a child chew and speak.
  • Clean your baby's gums with a dampened piece of gauze or washcloth, and switch to an infant toothbrush once the first tooth appears.
  • Brush your child's teeth until he or she can tie a shoe lace. Use a child-sized toothbrush with only a 'pea' sized dot of fluoride toothpaste and don't allow your child to swallow. If your child is likely to swallow the toothpaste, use a 'smear' amount of toothpaste to cover just the tips of the toothbrush. You almost shouldn't see the toothpaste with a smear amount.
  • Around age six your child should be coordinated enough to brush her/his own teeth with an appropriate sized, soft-bristled toothbrush.
  • Brush at least twice a day, supervising while your child is young.
  • Replace toothbrushes every three months and never allow sharing.
  • If your child has been ill, replace their toothbrush as soon as they're feeling better.
  • Check to make sure that your child is brushing properly. Don't let them brush too fast or hard or miss areas.
  • Your child's teeth should be flossed at least once a day between all teeth that touch side-to-side. By age nine, most children will have the skill to floss on their own.
  • Eat nutritious foods and drink healthy beverages. Limit snacks, especially sugary or sticky sweets that cling to teeth (fruit-snacks are the worst). The best time to eat sweet foods is with a meal or at the end of a meal, when natural salivation will wash most of them away.
  • By age one; have your child examined by a pediatric dentist.
  • Your child should have an orthodontic check-up by age seven. Many potential problems can be more easily and economically fixed during growing years.
  • Once permanent teeth have come in, talk to your dentist about dental sealants and fluoride treatments.
  • Get regular dental check-ups and cleanings.
  • Gums should not bleed after flossing or brushing. (This can be a sign of poor oral hygiene or nutritional deficiency.)
  • Eat a balanced diet and limit between-meal snacks.
  • If your child has trouble using dental floss, try an interdental cleaner. Your dentist can recommend one and instruct your child on proper use.
  • Make sure your child uses a professional mouth guard for sports and play. While it won't prevent cavities, a guard can keep your child's teeth from being damaged. (Almost one third of all dental injuries happen in sports accidents.) Perhaps most important of all: set an excellent example! Let your child see you taking excellent care of your teeth. Show your child how to have a healthy smile for life.

Oral Cancer: Causes and Symptoms

Worldwide, there are 350,000 to 400,000 new cases of oral cancer diagnosed each year. Even with today's medical and dental advances, this number hasn't improved significantly in years. Oral cancer is particularly dangerous for two reasons... 1) it is routinely discovered late in its development and 2) oral cancer patients have a 20 times higher risk of developing a second cancer even five to ten years after the first diagnosis.

Doctors can't explain why one person gets oral cancer and another doesn't, even when they have the same risk factors. The known risk factors include:

  • Diet – Studies have shown that a diet low in fruits and vegetables may put you more at risk for oral cancer, and other studies indicate that a diet high in fruits and vegetables may protect against many types of cancer.
  • Smoking, Secondhand smoke and Tobacco Use – At least 75% of those diagnosed with oral cancer are tobacco users, including the so-called 'smokeless' tobacco.
  • Alcohol – Heavy use of alcoholic beverages increases the risk of oral cancer.
  • Smoking and Alcohol Use Combined – Those who smoke and drink heavily are 15 times more likely to develop oral cancer.
  • Sunlight – Prolonged exposure to sunlight is a causative factor in lip and skin cancers.

The symptoms of oral cancer can be painless or mimic the appearance of other, non-dangerous oral symptoms. For instance, a cancer lesion can look much like a common canker sore. Because the dangerous tissue changes of oral cancer can look and feel like the benign tissue changes that occur normally, it's important to have regular dental check-ups. Your dentist can see or feel many changes in your mouth that may not even be noticeable to you. Some symptoms that should trigger an alarm and a dental visit include:

  • A color change in the mouth, including white, red, smooth, or discolored patches
  • Ulcer or sore on lips or gums that doesn't heal
  • Rough, crusty or eroded spot that doesn't heal
  • A lump, mass, thickening inside the mouth or neck
  • Bleeding in the mouth (Healthy gums don't bleed! This can also be a sign of gum disease.)
  • Loose teeth
  • Pain or difficulty in swallowing, speaking or chewing
  • Pain or difficulty moving the jaws
  • Wart like masses
  • Hoarseness that doesn't go away
  • Numbness in the oral/facial region
  • Change in the way teeth fit together
  • Difficulty wearing dentures
  • Earache
  • Any oral change or soreness that doesn't go away or heal within two weeks

While an infection, gum disease, and many other problems and conditions can cause these same reactions, it's still very important that you see your dentist right away if you experience any of them. If your dentist or doctor decides that an area is suspicious, s/he can perform a biopsy of the area. A biopsy isn't painful or time-consuming and is inexpensive. In the case of oral cancer, a quick, early diagnosis can mean the difference between life and death.

Mouth Protection During Sports

Dental injuries are the most common type of injuries to the face, and 60% of facial injuries occur during sports practice. An athlete is 60 times more likely to suffer damage to the teeth when not wearing a mouth guard.

A mouth guard is a flexible piece of plastic that fits around the upper teeth and protects them from injury. In addition to protecting against direct damage to the teeth, by cushioning the lips and cheeks from the teeth or orthodontic appliances, a mouth guard helps prevent laceration and bruising. A mouth guard can also prevent serious injuries caused when the lower jaw is jammed into the upper jaw, including concussion, cerebral hemorrhage, jaw fractures and neck injuries.

There are several types of mouth guards. When choosing one, remember that a mouth guard should be flexible, comfortable, durable, odorless, tasteless, and easy to clean. A mouth guard should fit properly so that it protects your mouth, but does not interfere with breathing or speaking.

The least expensive mouth guard is a stock one sold in sporting goods stores. They come in small, medium, and large and are held in place by biting down. The disadvantage of these mouth guards is that the fit is not adjustable and may not protect your teeth as well as a more fitted model would. Holding these guards in place requires that you bite down, so they can interfere with speech and breathing.

The most commonly used type of mouth guard is also sold in sporting goods stores. They're called "boil and bite mouth guards," because they're softened in boiling water and then formed to fit your mouth. This type of mouth guard costs a little more than the stock types, but because it is formed around your teeth, it fits and protects your mouth better. However, it still may not cover all your teeth properly.

The best mouth guard for preventing injury is one that is custom made for you by your dentist. This type is a bit more expensive, but it is the most effective at protecting your mouth, face and head. Because it is custom fit to your teeth, it's also the most comfortable to wear. When you consider that the cost of fixing one broken tooth is more expensive than having a mouth guard custom made, the value is obvious.

Whatever type of mouth guard you choose, you should wear it for any activity in which there is a chance of contact with other participants or hard surfaces. Mouth guards aren't just for football and hockey. If you or your child rides a bicycle, participates in gymnastics, volleyball, skateboarding, or any sport or activity in which a facial or dental injury might occur, a mouth guard is a necessity. Half of all dental injuries can be prevented, and a mouth guard is an important aid in protecting your teeth, face and mouth.

We offer custom made mouth guards and Under Armor® boil and bite mouth guards. Ask us about these products now and always let us know if your child is enrolled in sports. Prevention is always painless and always less expensive than treating a dental injury.