Pediatric Dentistry


Pediatric Dentistry

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

Stainless Steel Crowns are recommended for back teeth having three or more surfaces of decay or in children requiring sedation and have decay between teeth in all four corners of the mouth. 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 chance that the tooth will require removal, called an extraction. An extraction becomes necessary if, during treatment, the tooth is found to be lacking enough structure to support a crown. 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 veneered ceramic stainless steel crowns or all white ceramic crowns are recommended for front teeth only.  They are necessary when a front tooth has three or more surfaces of small decay or large decay on one or two surfaces.

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 ceramic veneered stainless steel crowns or all white ceramic 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, ceramic crowns on front teeth can and sometimes do come off.  These crowns can not be adapted to fit a tooth like a stainless steel crown and will come off with sticky candies or trauma. These crowns can 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 ceramic is not possible.

Silver Diamine Fluoride, SDF

In order to stop the progression of tooth decay we offer Silver Diamine Fluoride, a professionally applied to decayed surfaces of a tooth. SDF 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 MI Paste or fluoride are not enough; we can now offer SDF to stop the cavity progression in the early stages, instead of waiting until a filling or restorative material is required.

White Fillings

Our practice places white fillings because they are durable, require less removal of healthy tooth than traditional silver fillings, and they look great.  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 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.


Tongue tie, lip or cheek ties.

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 may require an orthodontic evaluation at some point. 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 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.