Treatment Options

Release or revision of the frenulum can occur at various ages and for various reasons. Frenulum’s are typically located between the front upper and/or lower jaw (Labial Frenulum), under the tongue (Lingual Frenulum) and in some cases on the sides of the jaws and connecting out to the cheeks (Buccal Frenulum). Everyone has these frenulum’s and they are all part of our anatomy and make-up. Where the frenulum attaches and how it effects the oral structure it is connected to determines if a frenectomies procedure is needed or not.

Infant and Newborn Tongue and Lip Ties

Patients that have been referred for an evaluation for a suspected nursing issue that is impacting the child and parent breastfeeding relationship will be evaluated for a potential lingual and or labial frenulum issue. Lingual and/or labial frenectomies are deemed necessary after a thorough examination of the newborn or infant and an in depth history of both the mother and child’s symptoms. It is highly recommended that all patients that seek an evaluation have seen a lactation consultant or specialist to help rule out other potential problems. A large body of very useful knowledge can be found on Dr. Bobby Ghaheri’s Website at http://drghaheri.squarespace.com/ . Please refer to the download section for various articles that will elaborate on specific topics.

PDA no longer sees patients under 2 years of age for evaluation and treatment of Tongue & Lip Ties.

Please click here if you are interested in scheduling an evaluation for your infant with Dr. Bahn.

The visit to the dentist for a young patient can often be confused with a visit to the pediatrician or other medical specialist. Our goal is to set ourselves apart from any negative visits to the pediatrician’s office and create a new, comfortable experience for your child. During the first visit, and other following visits as needed, we like to use the Tell-Show-Do (TSD) Technique which will help to desensitize your child to our instruments we use like the mirror and tooth counter to show them how easy a dental visit can truly be.

We have found that some children learn best and feel more comfortable by watching others do the same procedure. Older children and siblings sometimes serve as a great model for younger patients to watch and realize how easy a procedure may be.

The use of a papoose board is an advanced technique in which a child is gently wrapped in a Velcro blanket to help protect them. Young children often may grab or try and kick or move around in a dental chair. This behavior can be dangerous to not only the patient, but the pediatric dentist. This technique is used primarily in emergency situations or with extremely young or uncooperative children that have minimal dental needs.

Some patients may require the use of nitrous oxide to help assist in alleviating their anxiety or lessen the amount of anxiety prior to or during a procedure. Nitrous oxide, sometimes referred to as laughing gas, has a relaxing effect on the body and allows for the dentist to more efficiently work and perform high quality dental work. The purpose of the nitrous oxide is to relax and lessen anxiety for the patient and in certain patients it can greatly reduce of lessen a gag reflex, which can make dental work difficult to tolerate. Nitrous oxide is NOT intended to make your child go to sleep and at all times the child will be awake and able to easily talk the dentist or assistant. Nitrous oxide has been used and is currently used in the medical field and is extremely safe. If your child is scheduled for a nitrous oxide appointment, we ask they eat only a small meal 4 hours prior to the appointment, or if the appointment is early in the morning that they have an empty stomach. If you child takes daily medications, please may the dentist aware so they can either tell you to stop or continue taking the medicine. If your child has an ear infection or obstructed upper airway due to a cold or illness, we may not be able to safely and effectively use the nitrous oxide on that day’s visit.

Special Instructions

• We require that the child receive little or no food before the dental visit. Occasionally nausea or vomiting occurs when a child has a full stomach.
• Inform us in advance if your child has any respiratory challenges that may make breathing through the nose difficult or if your child is being treated for an ear infection.
• Please inform us if your child is pregnant, has sensitivity to medications, and/or is presently on psychiatric mood altering drugs or other medications

Oral sedation involves the usage of anywhere from a single medicine to a combination of medicines to help sedate your child. Some children have complex dental treatment needs and may need to be sedated to allow for the work to safely and effectively be completed. The usage of sedation is not for all patients and the dentist needs to be informed of any and all medical conditions (both past and present) that the child may have so they can be scheduled properly. Please inform the dentist of all medicines that the child currently takes or has been prescribed by their physician. On the morning of the sedation appointment your child MUST not have eaten since midnight and must have an empty stomach. This is for the patient’s safety and for this reason we only are able to perform oral sedations during the morning. A pediatric dentist will review your child’s medical history with you in depth on the day of the sedation and ask many questions about your child’s current health. We will listen to the child’s heart and lungs to ensure they are clear and check their throat and tonsils to make sure they have a good airway. Based upon the child’s dental needs and behavior we will give them a specific combination of medicine to drink. This medicine can take from 15 minutes, up to 40 minutes to start causing sedative effects on the child. The time will vary depending on the specific type of medicine in which your child was given. Your child will sit with you in a special waiting area until the proper amount of time has passed. We will ask you to assist your child to the restroom prior to going back with the pediatric dentist for their dental work. Most all children will become more sedate and clam as the medicine starts to work, but a small amount will become more active. We ask you sit with the child quietly so they do not hurt themselves or any other patients around them. Once the child is taken to get their dental work done we will add nitrous oxide, if needed, to help assist in the sedation. The patient will be monitored at all times by the pediatric dentist and with other monitoring equipment. The child’s procedure may be as short as 15 minutes or last over an hour, depending on the patient’s cooperation and dental needs. Radiographs can be taken easily during the sedation procedure if they were not possible prior to the appointment. The goal of sedation is to not have the patient completely asleep during the procedure, but in a state of consciousness that is lessened and allows for the patient to follow simple instructions as needed. In rare cases, some patients will not sedate well and other treatment options are available. They may include IV sedation or General Anesthesia in a hospital setting.

Some patients are not good candidates for oral sedation, or may have not sedated well enough with oral medicines and require an IV sedation. IV sedation is an option in which a small catheter is placed in a hand or arm ideally to allow for medicine to help sedate the child. If obtaining an IV is difficult due to the patient’s behavior, we may utilize a medicine that is “mist” into the nose to help calm the child and assist in obtaining the IV.

Some patients need to be seen in a hospital under general anesthesia to have dental work completed for a wide variety of reasons. Certain medical conditions, the patient’s age, weight, development or past dental treatment history may require a patient to be seen in the hospital. The patient’s safety is most important and the use of general anesthesia is a last resort for treating patients. The child will be seen at either St. Christopher’s Hospital or Episcopal Hospital where our pediatric dentists have operating room privileges. The site at which your child is seen is determined by their medical needs and insurance provider. Again, the child’s safety is imperative and a top priority. Operating room time is EXTEREMELY limited and a wait can be expected to obtain an appointment due to scheduling. If an OR appointment is recommended by the pediatric dentist, the parent will be contacted by our OR Coordinator to review the patient’s medical history, insurance and other policies and procedures. We will help to determine if your child will need insurance referrals, medical clearances and any dental co-pays you might have. On the day of surgery we ask your child has not eaten or drank anything since the night prior. Serious medical problems can arise if your child ate or drank anything prior to their operating room appointment. A nurse, medical anesthesiologist and pediatric dentist will all review your child’s medical and dental history and needs for that day and explain the procedure at that time. Once your child is asleep the procedure may take anywhere from 30 minutes up to 2 hours to complete depending on the complexity and overall needs of your child. Radiographs will be taken in the operating room on the day of surgery if they are needed.