11601 US Hwy 290 West, Suite
B105, Austin, TX 78737

Dental FAQ

Dental FAQ

GENERAL QUESTIONS SECTION

FRENECTOMY (TONGUE-TIE & LIP-TIE REVISION) SECTION

BABY OR INFANT-RELATED QUESTIONS SECTION

SCHOOL-AGED CHILDREN RELATED QUESTIONS SECTION

General Dental Questions

Q: Why should children see a pediatric dentist?

A: A pediatric dentist has two extra years of specialized training after the four years in dental school. Pediatric dentists are dedicated to the oral health of children from birth through the adolescent years. Newborn babies, infants, children, & teenagers all have different needs and require different approaches in dealing with their behavior, guiding their dental development, and helping them avoid future problems. A pediatric dentist is best qualified to meet these needs including those of special needs patients. We love to see children with special needs and we talk to them and treat them as a human being whether or not they can comprehend what we are saying or doing. Each child regardless their mental or physical state is treated with compassion and special care yet allowing them to feel important and as “normal” as possible during their dental visit.

Q: Why do you have to take so many x-rays?

A: For children that are new to our office, it is necessary to obtain radiographs of the back teeth that show the doctor the surfaces in between the teeth to check for decay. It is important to also obtain radiographs that show the roots and the bone surrounding both the back and front teeth to check for presence or absence of pathology such as soft or hard tissue tumors, extra teeth, and proper development of both the baby and adult teeth. Other potential problems areas that would be missed include but are not limited to cysts, supernumerary or congenitally missing teeth, pathology such as odontomas, etc…The earlier an abnormality is detected, the sooner it can be treated limiting the amount of damage it can cause your child’s mouth. For children who are established patients, sometimes radiographs are not necessary depending on their caries risk and/or what radiographs were taken at the previous visit.

Q: What are dental sealants and how they work?

A: Sealants are a clear or white coating applied to the chewing surfaces of the teeth that have grooves to help keep them cavity-free. Sealants fill in the grooved and pitted surfaces of the teeth, which are hard to clean even by the smallest toothbrush bristle. Relatively fast and comfortable to apply, sealants can effectively protect the chewing surfaces of the teeth for many years. It is recommended that your child not chew on sticky foods/candy or crush hard foods or chew on ice when sealants are applied to extend their longevity. It is important to note that sealants may not be feasible to place on a child that is uncooperative and/or has a hypersensitive gag reflex. We do offer fluoride-free sealants should you prefer these.

Q: What causes tooth decay?

A: There are four main things that contribute to tooth decay—a tooth, bacteria, sugars or other carbohydrates and time. Dental plaque is a thin, sticky, colorless (or white) deposit of bacteria that constantly forms on everyone’s teeth. When you eat, the sugars in your food cause the bacteria in plaque to produce acids that attach the tooth enamel. With time and repeated acid attacks, the enamel breaks down and a cavity forms.

Q: How should I clean my baby’s teeth?

A: For babies and infants: use a soft toothbrush with a small head, especially one designed for infants. Brush the teeth twice a day, especially at bedtime to remove plaque and bacteria which can lead to tooth decay. Start using a toothpaste that contains xylitol beginning with the eruption of the first baby teeth using a small smear for children under 3 years old.

Q: Should I use toothpaste to brush my baby’s teeth? Which toothpaste do you recommend?

A: Yes. Toothpaste can be used for babies but limit the amount to a very small smear on toothbrush. We recommend to use a toothpaste that contains xylitol such as Spry Kid’s toothpaste or any other brand that contains xylitol. For children 3 years old and older a pea size amount of toothpaste can be used. There are a variety of appropriate toothpaste brands and flavors to choose from at your local health food store.

Q: My child plays sports. How should I protect my child’s teeth?

A: A mouth guard should be a top priority on your child’s list of sports equipment. Athletic mouth protectors, or mouth guards, are made of soft plastic and fit comfortably to the shape of the upper teeth. They protect a child’s teeth, lips, cheeks, and gums from sports-related injuries. Any mouth guard works better than no mouth guard, but a custom-fitted mouth guard fitted by our doctor is your child’s best protection against sports-related injuries.

Q: Does my child truly need to come in for check-ups every six months?

A: Yes, in addition to detection of cavities, children need their dental development checked for exfoliation and eruption of teeth, habits that may alter function, skeletal discrepancies, ankylosis, fusion and gemination, and any pathology. In regards to cavities, we have seen cavities form in less than a year, sometimes even as fast as 6-9 months! It is important to detect them early to treat them with white fillings rather than when they are very large in size and the teeth may require crowns.

Q: My young child goes to school can his appointment be after school?

A: For children younger than 8 years of age that need treatment, we prefer they are seen early in the morning. Children are better able to cope in the morning when they are well rested. For children older than 8 years and teens treatment can be scheduled later in the morning or in the early afternoon.

Q: Is it possible to treat my child without use of sedation, nitrous oxide gas, restraint, or verbal behavior management?

A: This will depend on the child and the situation. For very young, anxious children with extensive treatment needed, it is not possible to treat without sedation, some sort of passive restraint or verbal guidance. For older children and/or small treatment plans it may be possible to treat without any of the above.

For children that are younger than 3 years of age or those with complicated medical histories, who require immediate or extensive treatment, it is usually necessary to use general anesthesia since they are usually not candidates for in-office oral sedation due to age and weight.

For babies and infants, it is necessary that they are restrained by you the parent or legal guardian so that the doctor can conduct the dental examination. It is normal for children this age to cry and be guarded. It is important that you remain calm and are supportive following the doctor’s recommendations so that the visit can be a short as possible and your child’s apprehension is short lived.


 

Q & A Session on Frenectomy (also known as tongue or lip tie revision)

Q: Do I need a referral from another doctor?

A: No. We are considered a primary care provider so you do not need a referral from another doctor or specialist. However, it is highly advisable to have an evaluation with a lactation specialist, IBCLC, prior to making an appointment for your baby. In addition, if you do have additional diagnostic information from another provider we encourage you to share that with the doctor during the exam visit.

Q: How young is too young to have my baby evaluated for a lip or tongue tie?

A: It is never too young to have your baby evaluated, we examine newborns all the time sometimes babies are only a day old. It is best to have your baby revised if it is indicated at a younger age rather than waiting since your baby can form habits and compensations which may require your baby to have additional therapy. In some cases, additional therapy is needed to fully rehabilitate the oral-facial structures regardless of the age.

Q: Will the first visit be considered a consultation or an exam visit?

A: It will be an exam visit since it does include a physical examination of the oral cavity, which is needed for full diagnosis and treatment plan recommendations.

Q: Do you have a referral network for bodywork or other therapists?

A: Yes, we do. When Dr. Evy made the decision to treat newborn babies, older babies, children, and teenagers with tongue tie and lip tie restrictions, she started a support group with other specialists in the area to treat these issues in a multi-factorial way. Removing a tongue or lip restriction does not cure all the problems babies and children experience by itself, it almost always requires a team approach and different types of therapy to fully rehabilitate these babies. We have a network which consists of lactation consultants (IBCLCs), speech language pathologists, midwives, cranio-sacral therapists, pediatric chiropractors, and myofunctional therapists. Please ask us for a recommendation.

Q: Will just having the surgical procedure conducted on my baby help correct my breastfeeding issues?

A: Caring for you and your baby is truly a team effort and we highly recommend that you continue to work with your (IBCLC )lactation consultant. For some babies, if there are no other problems with the cranium, head, neck, or back, and your baby is a newborn at the time of the revision, the likelihood of additional nonsurgical therapy is low. However, if there are other problems contributing to an improper latch, changing the anatomy of the frenum (lip tie or tongue tie) by surgical removal alone will not fully alleviate all the symptoms. Some babies require additional therapy, i.e speech language pathology therapy for suck, swallow, range of motion, lateralization of tongue, & strengthening training, craniosacral therapy to release tensions deep in the body to relieve pain and dysfunction, or chiropractic treatment for possible nerve interference and to correct subluxation/misalignment that may exist.

Q: Will any pain medication be given to my baby before conducting the procedure?

A: In most cases, yes. Dr. Evy has a safe specially compounded topical anesthetic and local anesthetic available for injection when necessary. Dr. Evy will address this question in a more individualized way once she has examined your baby. For older children, adolescents, and adults, topical and local anesthetic are used for comfort during the procedure.

Q: Can I breastfeed my baby prior to the procedure?

A: Yes, you can, however, if you are planning on having the surgery done in the same visit, we recommend you wait until after the procedure is completed to prevent regurgitation and possible aspiration of the milk by your baby.

Q: I have a toddler who I think needs to have the procedure conducted, what options do I have as far as sedation or general anesthesia is concerned with the use of the laser?

A: If your toddler is 16 months or younger, we may be able to treat him/her without any use of oral sedation or general anesthesia. It depends on your level of comfort in regards to physical restriction during the procedure. Since at this age they are usually stronger and more mobile, it does create a certain level of difficulty to treat. There are a couple of dental aids that help us maintain your child’s mouth open during the procedure. Once the doctor has examined your toddler she will be able to give you the treatment options available.

A child between 16 to 23 months may need to wait until age of two when oral sedation based on your child’s weight can be used. If a child has other dental needs (extensive dental decay) that need to be addressed promptly, general anesthesia may be indicated to treat both decay and any restrictive attachments of the lip and tongue. Dr. Evy usually does not recommend general anesthesia to treat a tongue-tie or lip-tie unless is absolutely necessary and the benefits outweigh the risks.

Q: Will just having the surgical procedure conducted on my baby help correct my breastfeeding issues?

A: Sometimes. It depends on whether or not your baby has other problems that need to be addressed. If there are no other problems with the cranium, head, neck, or back, and your baby is a newborn at the time of the revision, the likelihood of additional nonsurgical therapy is low. However, if there are other problems contributing to an improper latch, changing the anatomy of the frenum (lip tie or tongue tie) by surgical removal alone will not fully alleviate all the symptoms. Some babies require additional therapy, i.e speech language pathology therapy for suck, swallow, range of motion, lateralization of tongue, & strengthening training, craniosacral therapy to release tensions deep in the body to relieve pain and dysfunction,or chiropractic treatment for possible nerve interference and to correct subluxation/misalignment that may exist.

Q: How long does the laser frenectomy appointment usually last?

A: The laser frenectomy examination alone may take 20-30 minutes including showing you the stretching exercises, giving you all the information about the procedure, and answering questions you may have. Usually the more informed you are prior to visiting our office, the shorter the appointment is but we encourage questions even if you think you know everything about tongue-tie and lip-tie laser revision. The procedure itself takes a small amount of time and we take your baby to you immediately once we are finished.

Q: Am I allowed to stay in the room with my baby while the procedure is being conducted?

A: Due to state laser guidelines and regulations, we have you wait in our special breastfeeding area or in the reception area during the procedure. In addition, Dr. Evy prefers to focus fully on your baby so that we may finish the procedure quickly. We invite you to trust us and know we will take care of your baby, if the procedure takes a little bit longer than anticipated it usually means it is because we are being as careful as possible and properly removing the tie(s), especially when revising a baby that moves excessively and has very thick or deep ties.

Q: Will my baby bleed extensively on the area being revised?

A: Usually not. Since the laser cauterizes the arteries and veins of the area being revised and since there are no major arteries or veins within the tie (frenum), there usually is minimal or no bleeding observed. If there is, it is minimal and by the time we place your baby in your arms there is no longer any bleeding visible.

Q: What will happen if I do not conduct the post procedure exercises?

A: The risk of re-attachment is higher than if the exercises are conducted as instructed. Some individuals claim exercises don’t play a major role in re-attachment; however, well-respected doctors such as Dr. Kotlow, Dr. Margolis, and Dr. Ghaheri recommend them to increase the success of the revision. At Green Apple, we have seen how proper exercises have produced better results vs no or improper exercises. At the one-week follow up visit, if Dr. Evy suspects re-attachment has occurred already, she may mechanically separate or open the revision area which may set you back another week in healing time.

Q: Is my baby going to be in pain after the procedure? What can I use for pain management?

A: On the day of the procedure babies don’t usually experience discomfort. The discomfort usually sets in on day two and can last up to day five post-revision. However, every baby is unique and therefore every baby experiences the healing process and the level of discomfort differently. We recommend skin to skin contact with your baby, allow your baby to latch on you as much as possible whether for feeding or just for soothing/comfort. You can freeze some breast milk and place small shavings of it in your baby’s mouth and allow it to melt. You may also use natural coconut oil during the stretching exercises.

Some parents report using Hyland’s teething gel/tablets, rescue remedy, or arnica with success. We have a tongue-tie remedy available at our office that contains several herbs to help your baby with discomfort. In addition, based on your baby’s weight, you will have a calculated dose of infant’s Tylenol in your post-op instructions should your baby develop a mild fever or need it for pain management.

Q. What else can I expect post-revision?

A: Some babies may sleep more in the days following the revision and breastfeed less often, we suspect this is their way of dealing with the healing process. Some babies may have shorter and more frequent breastfeeding episodes. You may notice a great latch on the day of the revision and then not as great during the days following the revision due to soreness setting in and new oral musculature starting to be used post-revision when the tongue has more freedom to move. This is similar to training for a marathon with one leg having restrained musculature, if those muscles are freed you will not be able to run the same way until you re-train and strengthen those muscles that have now been freed. Many times the tongue needs time to adjust or even need re-training if it has been compensating for a while. Remember, sucking begins in-utero so even though your baby may be a newborn, he/she may still need time to adjust or he/she may need to have therapy to strengthen the oral musculature.

In addition, your baby may also cry during the stretching exercises and this is normal considering you are stretching tissue in an open wound. You may see minimal bleeding during the exercises but this is usually not a concern since it stops quickly, very few parents have reported bleeding. Increased drooling has been observed as a side effect of the surgery but it returns to normal as the wounds heal.

Q: Does my insurance cover the laser frenectomy procedure?

A: We usually don’t find out until your claim is processed by your insurance company. Over time, we have learned that each plan is unique with different stipulations, deductibles, and coverage (certain insurance plans require (or highly recommend) a pre-authorization prior to the procedure). We highly recommend you contact your insurance plan and ask about coverage for the procedure. Keep in mind, we are a dental office and therefore we only bill claims to specific Dental PPO plans. Therefore, when contacting your insurance plan, have them look at dental codes coverage. We are NOT contracted with any medical plans including any HMOs and do not file any medical claims.

Please understand that we file dental claims as a courtesy. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance plan handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will cover in your dental claim. We cannot be responsible for any errors in filing your insurance as we file claims as a courtesy to you.

We highly recommend you contact your insurance plan to check the status of a claim. Please remember any estimates in your treatment plan are just that, an estimate, and we will not know how much your insurance reimbursement is until your insurance plan processes your claim.

Q: Does my baby need to be ACTIVE on dental insurance for the laser frenectomy procedure to be covered?

A: Yes. An insurance plan will usually not consider a claim for reimbursement if your baby is not active on the plan on the date of service. We are only contracted with specific Dental PPO plans. Please see previous question.

Q: Does medical insurance cover the procedure?

A: We do not know. We are not in contract with any medical insurance plans including any HMOs. We encourage you to call your specific insurance plan to find out. You can be provided a superbill for you to send to your insurance and seek reimbursement on your own.

Q: Will you bill my medical insurance?

A: No, however we can provide you with the claim form (superbill) that you can then submit directly to your insurance. If they approve and reimburse for all or part of the procedure, they should reimburse you directly. We do not have a contract or negotiated fees with any medical insurance and we do not receive any reimbursement from them.

** For additional information please visit our FB page for daily procedure related updates.

Helpful Articles on Frenectomy

  • For a variety of articles from 30+ years of experience Dr. Kotlow has in private practice treating tongue tie and lip tie, please visit his website here.
  • In their Spring 2004 Newsletter, the American Academy of Pediatrics, finally recognizes that tongue-tie is not an outdated concept and that it can affect breastfeeding in a negative way.
    Read more here
  • Short Lingual Frenulum and Obstructive Sleep Apnea in Children

 

Baby or Infant-Related Dental Questions

Q: How should I clean my baby’s teeth?

A: For babies and infants: use a soft toothbrush with a small head, especially one designed for infants. Brush the teeth twice a day, especially at bedtime to remove plaque and bacteria which can lead to tooth decay. Start using a toothpaste that contains xylitol beginning with the eruption of the first baby teeth using a small smear for children under 3 years old.

Q: Should I use toothpaste to brush my baby’s teeth? Which toothpaste do you recommend?

A: Yes. Toothpaste can be used for babies but limit the amount to a very small smear on toothbrush. We recommend to use a toothpaste that contains xylitol such as Spry Kid’s toothpaste or any other brand that contains xylitol. For children 3 years old and older a pea size amount of toothpaste can be used. There are a variety of appropriate toothpaste brands and flavors to choose from at your local health food store.

Q: At what age should my baby/child have his/her first visit?

A: As a general rule, every baby should see a pediatric dentist by the first birthday. However, your child can have the first visit when the first tooth erupts, between 6 and 12 months of age, usually.

Q: What is baby bottle decay and how can I prevent it?

A: Baby bottle decay is a pattern of rapid decay associated with frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breastmilk), formula, juice, and other sweetened drinks. It happens when a child goes to sleep (day or night) while breastfeeding or bottle feeding. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acid which causes decay. Breastmilk alone does not cause tooth decay, however, you should brush or wipe your baby’s teeth with a wet soft cloth or xylitol wipes after feedings (including at night). Another factor associated with this decay may be an upper lip tie which can create a reservoir for liquids to remain in contact with the teeth for longer periods of time. In addition, during sleep, the flow of saliva is reduced and the natural self-cleansing action of the mouth is diminished. If you must give your baby a bottle for comfort when going to sleep, it should only contain water. If unable to do this, dilute liquids gradually until it’s mostly water to decrease sugars on the surfaces of the teeth.

Q: How soon should I start flossing my child’s teeth? How often?

A: As soon as your child’s teeth are in contact with each other and the toothbrush cannot clean the surfaces in between the teeth start flossing. It should be done at least once a day, especially before bedtime to remove all food trapped between the teeth throughout the day. You can use regular floss or use floss holders which may be easier for you and your child to hold.

Q: How does thumb sucking harm my child’s teeth?

A: Prolonged thumb sucking can cause crowded crooked teeth or bite problems. Thumb sucking changes not only the position of the teeth but also affects the growth and shape of the bone holding the teeth in place. The thumb places pressure on the upper arch causing narrow arches and the upper front teeth to incline forward resulting in an open bite. At times, if a child is still sucking the thumb or fingers when the permanent teeth arrive, a mouth appliance (palatal crib) may be recommended to help stop the habit. These appliances are recommended only as a reminder for a child that is ready to stop the habit to help him/her remember not to place the thumb or finger in the mouth. It is not recommended for a child that does not yet understand the purpose and benefits of it. Some children will stop this habit on their own.

Q: When do the first teeth start to erupt?

A: At about 6 months, the two lower front teeth (central incisors) will erupt, followed shortly by the two upper central incisors. The remainder of the baby teeth appear during the next 18-24 months but not necessarily in an orderly sequence from front to back. At 2 to 3 years, all of these 20 primary teeth should be present.

Q: How can I help my child through the teething stage?

A: Sore gums when teeth erupt are part of the normal eruption process. The discomforts is eased for some children by use of a teething toy, a piece of toast, a cold (refrigerated not frozen) teething ring, or by your child sucking on an ice cold moist clean washcloth. You can also use Hyland’s teething gel which has all natural ingredients to help soothe your child’s teeth.

Q: I notice a space between my child’s two upper front teeth. Is this a concern? Does something need to be done?

A: It is normal for baby teeth to have gaps/spaces between them. In fact, gaps between baby teeth mean there is more space available for permanent teeth when they erupt. Since permanent teeth are usually larger in size, sometimes even twice the size of baby teeth, it is a good sign to see gaps between baby teeth.

When a gap is larger than average, it may be caused by a lip-tie and it may need to be evaluated. If the lip-tie is a class IV and wraps into the palatal papilla, there is a higher chance that it needs to be revised to prevent a large gap between the permanent upper front teeth. The lip revision doesn’t always prevent your child from having braces if there are other crowding or malocclusion problems that need to be addressed.

Q: If my child gets a cavity in a baby tooth, should it still be filled—aren’t they just baby teeth?

A: They’re not just baby teeth. They are important for many reasons. They provide function of chewing during the years of greatest body growth; esthetically, they provide an attractive appearance and smile; they play a role in speech development; and they aid in forming path that permanent teeth can follow when they are ready to erupt. Some children have their baby teeth until they are 12 years old or older. Pain, infection of the gums and jaws, impairment of general health, and premature loss of teeth are just a few of the problems that can happen when baby teeth are neglected. Also, because tooth decay is really an infection and will spread, decay on baby teeth can cause decay on permanent teeth. Proper care of baby teeth is instrumental in enhancing the health of your child.

In my years of experience, I’ve seen several children end up in the hospital for a severe tooth infection that spread through the neck area compromising the airway or the upper face area with risk for infection traveling to the brain, due to neglect or refusal to treat and follow recommendations. In some cases the infection spread quickly and unexpectedly.


 

School-Aged Children Dental Questions

Q: My child has a new tooth coming in behind the front ones—is this a problem?

A: Probably not, but it can be a sign of teeth crowding. When this happens, it is usually due to a narrow mandible that lacks enough space to allow teeth to erupt into proper position. If the baby teeth have no mobility and child is not able to wiggle them on his/her own, we may have to remove them to allow the permanent teeth into better position, especially when the permanent teeth have fully erupted. When baby teeth are very mobile, we highly encourage children to remove them on their own.

Q: If my child has trauma to the mouth, can we be seen immediately?

A: If it is during office hours, yes. If it is after office hours or during the weekend, we encourage you to contact our emergency line which is provided to you when you call our office phone number. The doctor will advise you if your child needs to be seen immediately or be seen when the office is open.

More FAQs coming soon! Please feel free to submit any questions you’d like added to this section.