America's Pediatric Dentists - The Big Authority on Little Teeth

AAPD | Mouth Monsters

The Perfect Smile?

AAPD President Dr. Delarosa explains when cosmetic dentistry may or may not be right for children.

Cosmetic dentistry hub visual_compressed v2Most parents have experienced that mortifying moment when a child loudly points out another person’s physical differences in public. Although children ultimately outgrow that outward behavior, their keen perception of others and themselves continues to grow. And in many cases, dealing with their own physical differences can lead to emotional turmoil.

According to a study published in the September-October 2015 issue of Pediatric Dentistry, four- and five-year-old children already had negative social perceptions of others and themselves regarding altered dental aesthetics. In addition, a recent issue of the American Journal of Orthodontics and Dentofacial Orthopedics found a high correlation between the appearance of a child’s teeth and being targeted by bullying.

Sadly, I’ve seen parents concerned about these issues in my own practice as well. Because a person’s smile (and the condition of the front teeth) is the first thing we notice, having a pleasant appearance has an effect on an individual’s psyche. The opposite is also true in some individuals who have teeth in poor condition. They can be embarrassed, uncomfortable in social settings, and avoid smiling and speaking.

As parents, we want to help our children have happy, healthy childhoods. That’s why it’s important to consider the reasons why cosmetic dentistry may be a viable solution to pediatric dental issues.

When Is Cosmetic Dentistry Right For Your Child?

The two biggest issues we see in children requiring cosmetic restorations are trauma and decay. In the very young child, I see falls as the most common reason for these dental injuries, and as children get older, I see more sports-related or collision injuries.

Meanwhile, 60 percent of children have experienced dental decay by age five. In children with severe tooth decay unfortunately the top front teeth are the first to show signs of visible decay or altered appearance due to cavities. Both of these issues present a major problem, and in restoring teeth, there are a range of treatments depending upon the extent and severity of the problem.

In the discussion of cosmetic dentistry, I also often receive requests for teeth whitening or bleaching, which the American Academy of Pediatric Dentistry doesn’t advise for children prior to their mid- to late-teens. There seems to be more and more pressure today to have the perfect smile and teeth, but parents need to discuss with pediatric dentists procedures that are purely cosmetic. These have less to do with disease or trauma, and more to do with the psychological aspects of self-esteem, self-confidence and enhanced appearance.

What Pediatric Cosmetic Treatments Look Like

If a traumatized tooth has suffered significant structural or nerve damage, a cap or crown would be the treatment of choice.

For small cavities in the front teeth, restoring those teeth usually involves a cosmetic filling. Choosing to restore teeth, and what materials to use, depends on the child’s risk for dental disease. If the child is at high risk for developing cavities, then more aggressive treatments such as crowns may still be the best choice.

Procedures vary in time depending upon how many teeth need to be restored. If one or two teeth need to be restored, this is often handled in the office with local anesthesia and perhaps nitrous oxide gas (also known as laughing gas).

The most serious situation for us is the three- or four-year-old with 16 to 20 teeth requiring cosmetic restorations. This child is typically treated in a surgical setting under general anesthesia. This procedure involves placing multiple crowns and nerve treatments, and it can easily take more than an hour to complete.

If your child has issues that impact their physical appearance, talk to your pediatric dentist. It’s important for parents to understand all of the treatment options – including no treatment – so they can make an informed decision for their children.

As parents, we want what’s best for our children, and in some cases that might mean cosmetic dentistry. But this choice isn’t about crafting “the perfect smile” for our children, but rather setting them up for success physically, developmentally and socially. After all, seeing a child smile is any parent’s definition of perfection.

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Robert L. Delarosa, D.D.S

Dr. Robert Delarosa is President of the American Academy of Pediatric Dentistry and founding partner in a group private practice in Baton Rouge, La. He is a graduate of the Louisiana State University School of Dentistry and received his certificate in pediatric dentistry from the University of Texas Health Science Center at San Antonio. He was board certified in 1991 and is a fellow in the American College of Dentists. Dr. Delarosa has had leadership roles in numerous dental professional organizations at the state and regional levels, and was the Louisiana state leader for the AAPD Head Start Oral Health Initiative. As AAPD president, his presidential agenda will include the creation of a task force to investigate the growing debt burden of recent graduates and potential avenues of relief, as well as continuing to act upon the recommendations of the previously created task forces, specifically identifying future volunteer leaders and enhancing chapter relations. And finally, he will continue to work closely with the board and staff to sustain the value of AAPD membership and organizational strength.