OUR SERVICES

New Patient Oral Wellness Examinations

As a new patient at Little Star Pediatric Dentistry, we want to welcome you and your child to our office. Our goal is to make your child feel comfortable in our office by gaining their trust and helping to alleviate their fears. Our kid-friendly staff is skilled at helping children have a positive experience in our office.

The American Academy of Pediatric Dentistry and Little Star Pediatric Dentistry recommended that patients visit the dentist at least every six months in order to assess and address their changing and developing oral needs. These visits are essential in keeping gums and teeth healthy, and in minimizing any potential problems that may be starting. At this visit, a thorough oral examination will be performed, assessing your child’s oral hygiene, teeth, bite, growth and skeletal development, and overall oral health.

A typical new patient or recare examination will include the following:

• Assess child’s medical health
• Oral hygiene examination and assessment of gum health
• Detailed evaluation of all teeth
• Check for starting or existing cavities
• Monitoring status of existing fillings and dental work
• Evaluation of the bite and dental occlusion
• Assessment of growth and skeletal development of the jaw and surrounding structures
• Comparison of changes from previous visits
• Thorough dental cleaning with removal of all plaque and tartar
• Demonstrate correct brushing and oral hygiene techniques
• Detailed diet, oral hygiene and anticipatory guidance instructions
• Fluoride treatment, as needed
• Digital X-rays, as needed
• Proactive preventive recommendations or treatment plan development, as needed

We’re happy to answer any questions and address any concerns you may have. We want this first visit to be educational and fun for both you and your child.

Dental Cleaning

An essential part of maintaining your child’s oral health is having regular professional cleanings. For most children, we recommend a professional cleaning every six months to keep their mouths healthy and avoid the number one chronic childhood infection: tooth decay.

During your cleaning appointment, we will:

• Remove plaque and tartar. Plaque is a sticky film containing bacteria that attack tooth enamel, causing cavities and inflaming the gums. Plaque left on teeth over time hardens and becomes calculus (tartar), which can only be removed with dental tools. Without proper care, plaque and tartar can lead to periodontal disease.
• Polish teeth. This final step removes minor stains and any remaining plaque, making teeth their whitest and brightest!
• Floss teeth. To remove all plaque, bacteria, and food caught in between the teeth.
• Treat with fluoride. Your dentist may suggest a fluoride treatment to help their teeth stay strong.

Home care, brushing and flossing techniques will be discussed and recommendations given.

Fluoride Treatments

Tooth enamel is dissolved and replaced constantly in the mouth, and fluoride makes that replacement material much stronger. Research indicates fluoride can help prevent cavities by:

• Making the tooth enamel stronger to protect against acids in the mouth formed by bacteria and sugar; and
• Helping reduce the amount of bacteria that stays on the tooth surface.

Water fluoridation is a common practice in U.S. public water systems. However, bottled water, home treatment systems and private well water may not be fluoridated. The use of fluoride toothpastes and mouthwashes and a diet that includes foods with natural fluoride may be sufficient. However, children under 6 with any history of decay and older children with a few cavities and other risk factors are at moderate to high risk for decay and may benefit from professional fluoride applications. Little Star Pediatric Dentistry will evaluate your child’s dental health and offer fluoride treatments in our office if needed.

Diet, Oral Hygiene, and Anticipatory Guidance Instructions

A child’s diet (solids, liquids, and snacking habits) is very critical to their oral health. It is important to spend time discussing their diet as certain foods and habits are damaging to the teeth and can cause cavities. We spend time learning and understanding your child’s diet and oral hygiene habits during the professional examination. As such, we will provide specialized recommendations based on your individual child’s needs. The goal always being to provide the proper education and tools to maintain proper oral care, a well balanced diet, and decrease the occurrence of dental cavities.

Digital & Panoramic X-Rays

Children’s mouths grow quickly and changes occur that cannot be seen in a visual exam. Digital Radiographs are an important component of proper dental diagnosis. While some dental cavities and conditions can be visually detected, others cannot without the aid of digital imaging. If X-Rays are not taken, certain cavities and dental conditions can be missed and not properly treated. There are various forms of radiograph techniques that we have available at the office. Each having it’s own benefit and diagnostic advantage. Their used helps evaluate the teeth and mouth for conditions such as cavities, erupting teeth, extra or missing teeth and bone disease.

Extra-oral Digital Radiographs

At Little Star Pediatric Dentistry we have the use of Extra-Oral Digital Radiographs. With this imaging tool, your child won’t have to struggle to hold the sensor in their mouth. Rather, they stand still while the machine moves around them and takes the images extraorally. This is a very new, innovative, and uncomfortable way for children to take X-Rays.

We are very aware and careful of limiting the radiation that is exposed to our patients. At Little Star Pediatric Dentistry we have the newest, and most advanced digital X-Ray units. As such, these devices very low amounts of radiation. The risk of radiation received from the X-Ray is much less than the risk of unidentified decay or other potential dental problems.

To protect your child, our office uses the most recent digital technology, which has greatly improved the safety, comfort and speed of X-Rays:

• Exposure to radiation is reduced by 80 – 90%!
• A wireless sensor in the mouth replaces the awkward biting down on plastic cases.
• With images available in seconds, there is no waiting for film to develop and visits are shorter.
• Images can be enhanced to show the fine details, allowing the doctor to diagnose conditions in the very early stages.

The frequency of dental x-rays varies from child to child, however those with a high risk of tooth decay will typically require dental x rays every six months to a year.

BPA-Free Sealants

The chewing surfaces of teeth have grooves (called pits and fissures) and indentations that help trap plaque and bacteria. These grooves are often too small for a toothbrush bristle to be able to clean out and are the areas on teeth most prone to decay. With time, this accumulation can turn into a cavity and need proper treatment. These grooves are present on various surfaces of all teeth but are most prevalent and deep on the back premolars and molars. Even the most careful brushing and flossing cannot fully clean these areas. Dental sealants are clear plastic coverings that protect the chewing surfaces from tooth decay by providing a barrier to food and bacteria. Application is simple and painless:

• The sealant is painted onto the tooth, filling depressions and grooves.
• Hardening takes place in just a matter of seconds.
• Most applications last several years with normal chewing and biting.
• Sealants can be reapplied as necessary.

Children should get sealants on their permanent molars as soon as the teeth come in — before decay attacks the teeth. Teenagers and young adults who are prone to decay may also need sealants. Sealants are a cost-effective prevention option, and when used along with regular dental check-ups and cleanings, provide the most effective defense for tooth decay. Little Star Pediatric Dentistry can apply them during a regular check-up.

Mercury-Free and Bio-Compatible Materials

At Little Star Pediatric Dentistry, we strive to provide the safest and healthiest material options for your child. As such, we are a mercury free office and do not use dental amalgam (silver fillings) as a restorative option, and have several metal-free options (BPA-free sealants and composites, and zirconia crowns). We believe in using material that is safe, biocompatible, and healthy for your child.

SDF

Coming Soon!

Mercury-Free and Bio-Compatible Materials

At Little Star Pediatric Dentistry, we strive to provide the safest and healthiest material options for your child. As such, we are a mercury free office and do not use dental amalgam (silver fillings) as a restorative option, and have several metal-free options (BPA-free sealants and composites, and zirconia crowns). We believe in using material that is safe, biocompatible, and healthy for your child.

Laser-Lip and Tongue-Tie Laser Revision

At Little Star Breathe, we are dedicated to treating infants, toddlers, and children with tongue-ties, lip-ties, buccal-ties and other tethered oral tissues with the use of advanced laser surgery.

Dr. Najmeh Hannanvash is a Board Certified Pediatric Dentist in San Diego, CA. She specializes in this procedure and is a preferred provider in performing laser frenectomies. She works very closely with multiple Lactation Consultants, CranioSacral Therapists, Physical Therapists, Chiropractors, Speech Therapists, Myofunctional Therapists, Occupational Therapists, Cranial Ostheopaths, and Pediatricians to ensure that her patients receive a comprehensive, full-circle treatment. Dr. Najmeh is truly passionate about this field and has built a portion of her practice around having a facility for families to receive the best care possible. She has spent years studying this procedure, has lectured on the topic at several local forums, and is locally involved as a member of San Diego County Breastfeeding Coalition and various other professional organizations.

What is a Tongue Tie or Lip Tie?

A tongue-tie or lip-tie is more common than one would think. It’s often misdiagnosed, or under-diagnosed, and thus the reason why it is so often missed at an early stage in life. It is a remnant of embryologic tissue that did not fully recede the first trimester, resulting in an excessively “tight” or taut fibrous attachment limiting the range of motion of the tongue and the lip. These limitations in movement can cause significant breastfeeding difficulties in addition to other health problems. These health problems include decay, crowding, spacing, speech difficulties/delays, improper food clearance, digestive issues, heightened muscle tension, open mouth breathing, airway compromise, sleep apnea, tension headaches, clenching, grinding, muscle fatigue and overall skeletal and craniofacial development.

What Is A Frenectomy or Frenotomy?

A frenectomy or frenotomy refers to a corrective procedure done to release a tight frenum. When done with a laser, the terminology is essentially interchangeable.

How Does the Laser Work?

All procedures are performed with the use of a CO2 laser. This is a cold, non-touch laser which allows for gentle treatment and optimal healing of the tissue. The laser seals the blood vessels as it works so there is little to no bleeding (unlike with scissors which often require an additional medicament to stop the bleeding). No sutures are needed. Additionally, the laser is bactericidal and sterilizes the wound and surrounding tissue. Therefore the risk of infection is very minimal.

Please read the following three sections and complete the Patient Intake Forms prior to arrival for your appointment.

How To Prepare Before The Procedure?

What to Expect During the Procedure?

What to do After the Procedure?

• This is a passive stretch that should be done when your child is asleep. The goal is to get the tongue up and against the palate (roof of the mouth) and to maintain that hold.
• This is a tongue strengthening exercise.
• View two demonstrations:
  • Dr. Hope Reyes and Karyn Johnson-Fernandez video
  • Michelle Emanuel video

Expectations

Be prepared for a few days of fussiness and discomfort as your baby adjusts to the new mobility and the wound goes through its various healing forms. Some babies take to the procedure immediately, and some take time to adjust. Both forms are fine and do not define a successful/unsuccessful revision. Generally, most babies take a few steps back before they are able to start moving forward. Meaning that breastfeeding might actually be harder initially until things begin to organize and the mechanics start working together properly. There is new mobility of the lip and tongue and your baby needs time to re-learn how to use them. Follow-up appointments will be instrumental in working this out.

Follow-Up Appointments

I prefer to see my patients about 1 week after the procedure to assess wound healing, re-attachment, daily stretches, and symptom changes. Further appointments can be scheduled on an as-needed basis. We will see each other for multiple appointments thereafter. It is important to commit to the follow-up visits to ensure proper healing and tissue formation.

It is VERY important to follow up with your lactation consultant after the revision for continued work. Now that the lip/tongue has optimized mobility, it is very important to re-learn and organize the movements. The same techniques that may have not worked before may be far more effective now that your baby has the appropriately functioning tools. Additionally, many babies will benefit from body work and other functional oral motor work. This helps detect and release body tensions to aid in a more appropriate breastfeeding relationship. We can discuss the benefits of this during your appointment.

Call Our Office For Any Of The Following:

• – Uncontrolled bleeding
• – Fever > 101.5
• – Signs of possible infection

The team at Little Star Breathe is trained to treat tethered oral tissues with care and precision. Call today to schedule your child’s consultation.

Pediatric Sedation Dentistry

Little Star Pediatric Dentistry is dedicated to providing the highest quality care for your child’s teeth. Your child’s response to their dental experiences can make a lasting impression – a positive experience will help your child feel confident when visiting a dentist. Some children may be unable, because of fear or inability, to cope with dental treatments, or may make uncontrolled movements that could cause injury to the child. Others may develop such a fear that they will have trouble cooperating during future visits or even refuse treatment. These children may be more comfortable and safe with sedation.

Nitrous Oxide

Oral Conscious Sedation

I.V. Sedation/In Office General Anesthesia

Nitrous Oxide

Also known as laughing gas, nitrous oxide is a very safe sedative that allows a mildly nervous child to become calm but still awake and able to talk to the dentist. A mask is placed over the child’s face and as they breathe through their nose, the child relaxes. The effects wear off very quickly when the gas is turned off.

Prior to your appointment

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, cough, congestion, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Your child should not have any food or drink for at least 2 hours prior to their appointment.

 Oral Conscious Sedation

If a child’s anxiety level cannot be soothed with nitrous oxide, using conscious sedation will cause the child to be drowsy or even to fall asleep. Depending on the treatment required and the child’s ability to cooperate, several different conscious sedation medications are available. Side effects may include nausea and vomiting, which can be minimized by following specific eating and drinking directions before and after sedation.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, cough, congestion, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing. Please bring a jacket for after the procedure.
• Help your child use the bathroom immediately upon arrival at the office.
• Your child should not have solids for at least 6 hours prior to the appointment and clear liquids for at least 4 hours prior.
• The child’s parent or legal guardian must remain at the office during the complete procedure.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely by an adult for the rest of the day. Keep your child away from areas of potential harm.
• Keep activity to a minimum. Your child should stay home from school and sport activities. They should be in a common living room area so you can monitor them throughout the day.
• Your child’s coordination and balance may be impaired for the day so aid them when leaving the office and going home.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• Some nausea is normal due to the medication that may still be in your child’s system. If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Excessive nausea and vomiting is not. Please call the office or take your child to the nearest emergency room.
• Please call our office for any questions or concerns that you might have.

I.V. Sedation/In Office General Anesthesia

If the dental treatment is extensive or difficult and the child cannot be calm enough or is unable to understand directions to tolerate the treatment, a general anesthesia may be recommended. General anesthesia will allow the child to remain asleep during the procedure and not feel any pain or remember the treatment. The procedure will be done at the office with both the dentist and an anesthesiologist. Both will be monitoring your child at all times.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, cough, congestion, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing. Please bring a jacket for after the procedure.
• Help your child use the bathroom immediately upon arrival at the office.
• Your child should not have solids for at least 6 hours prior to the appointment and clear liquids for at least 4 hours prior.
• The child’s parent or legal guardian must remain at the office during the complete procedure.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely by an adult for the rest of the day. Keep your child away from areas of potential harm.
• Keep activity to a minimum. Your child should stay home from school and sport activities. They should be in a common living room area so you can monitor them throughout the day.
• Your child’s coordination and balance may be impaired for the day so aid them when leaving the office and going home.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• Some nausea is normal due to the medication that may still be in your child’s system. If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Excessive nausea and vomiting is not. Please call the office or take your child to the nearest emergency room.
• Please call our office for any questions or concerns that you might have.

White Fillings

White or tooth colored fillings allow for a natural esthetic that makes the filling nearly invisible. These are used both on baby (primary) teeth and on permanent teeth. Primary teeth play a critical part in your child’s development, affecting their ability to:

• Chew food
• Develop strong jaw muscles and use of tongue
• Speak properly
• Maintain proper spacing for permanent teeth

When a tooth is cracked, disfigured or decayed, a composite (white) filling may be used to restore the tooth to prevent more extensive breakage needing a crown or to keep a primary tooth in place until the permanent tooth erupts. Composite fillings are tooth colored and can be closely matched to the existing tooth color, especially important in more visible areas of the mouth. These fillings are very durable and should last many years, but fillings in permanent teeth will most likely eventually need replacing. Good oral hygiene and regular visits Little Star Pediatric Dentistry will help fillings last longer and help you enjoy a pain-free, healthy mouth.

At Little Star Pediatric Dentistry, the materials used are BPA-free and biocompatible.

Nerve Treatment (Pulpotomy/Pulpectomy)

Saving a decayed or injured tooth is important to a child’s speech development, chewing and alignment of permanent teeth. When pulp tissue,  the nerves, tissue, and blood vessels in the core of a primary or permanent tooth, becomes diseased, some or all of the pulp may need to be removed. This procedure is known as children’s root canal therapy or pulp therapy.

• Pulpotomy. If the disease has not gone into the root, the diseased pulp is removed and the remaining pulp is filled with an antibacterial agent.
• Pulpectomy. When the pulp is diseased into the root canal, the entire pulp is removed and the roots are cleaned.

A stainless steel or natural-colored crown is placed on the treated tooth to provide structural support.

If the doctor determines that pulp therapy is the best treatment option for the affected tooth, Little Star Pediatric Dentistry can perform the therapy in our office.

Crowns (Stainless Steal & Zirconia)

Baby (primary) teeth are placeholders for the adult teeth, ensuring the adult teeth fit and grow in where they belong. When a primary tooth is decayed or damaged, it may be necessary to put a crown on the tooth to keep it in place until the adult tooth comes through. Depending on the location of the tooth, two types of crowns are available:

• Stainless steel. The back teeth need extra protection from chewing. Stainless steel crowns are stronger than tooth-colored crowns and normally last until the teeth naturally fall out.
• Esthetic. For most children, the front teeth can be covered with a tooth-colored crown.

Taking great care of your child’s teeth now will give them the best chance for healthy adult teeth. We can help you protect your child’s bright smile.

Extractions

The removal of single teeth may be necessary to maintain the health of your child’s remaining teeth, permanent teeth and mouth. After evaluating all options, extraction may be the best or only choice. Teeth are most commonly extracted due to:

• Interference with the growth of a permanent tooth
• Problems with long or misshapen roots
• Severe trauma or decay

After determining that extraction is necessary, we will discuss the treatment with you. In some cases, we may recommend replacing the extracted tooth with a space maintainer to keep the teeth and jaw from shifting and creating problems with chewing and dental health. Most tooth extractions are very routine procedures. Little Star Pediatric Dentistry will make sure your child is comfortable, using local anesthesia to completely numb the area. The mouth should heal and return to normal in just a few days.

Space Maintainers

When baby (primary) teeth are lost before the permanent teeth erupt, the space may need to be filled with a space maintainer (spacer). Not only are primary teeth used for chewing and speech development, they guide permanent teeth into the spaces where they belong without shifting, and protect the mouth from crowding and future orthodontic problems. Spacers are removed when the new tooth erupts.

Not every space needs to be filled:

• The four upper front teeth spaces will stay open on their own.
• If a permanent tooth is ready to erupt, your child may not need a spacer.
• But if space is already a problem, a spacer may be necessary.

Space maintainers are made of stainless steel or plastic, and come in two forms:

• Fixed – cemented onto the teeth on either side of the space
• Removable – looks like a retainer, used primarily for cosmetic space filling

Regular brushing and good oral hygiene are especially important. During your child’s regular dental check-ups at Little Star Pediatric Dentistry, we will inspect the spacers and follow the progress of the incoming permanent teeth.

Oral Appliances

More info will be added later.

Special Needs Dental Care

Children with special needs often have a greater incidence of tooth decay, gum disease and oral trauma. The staff Little Star Pediatric Dentistry has been specially trained to design a program to address your child’s specific needs. Close attention to oral health is especially important for special children for several reasons:

• Physical limitations and lack of proper motor function can make brushing and flossing difficult.
• Some medications and special dietary requirements may be detrimental to dental health.
• Some children require frequent medical treatments and doctors’ appointments, and it is understandable for parents to spend less time overseeing the child’s oral hygiene habits.

At your first visit, we will schedule enough time to ensure a thorough review of your child’s medical history and discuss the best preventative dental care and treatment for your child. Home care takes just minutes a day and prevents needless dental problems. Starting dental care early and being diligent with daily oral hygiene can minimize the financial and emotional costs of oral health and help your child enjoy a healthy smile for a lifetime.

Dental Emergencies

Injuries to the mouth and teeth need to be addressed immediately. Getting to Little Star Pediatric Dentistry office quickly may save a tooth, prevent infection and reduce suffering.

Please call our office so that we may advise you on how to manage and handle the emergency. Often a picture helps so don’t hesitate to take a picture of the tooth or site of injury and send it to us for better after-hours evaluation.

Here are some details on how to handle the following emergencies:

Toothache

Soft Tissue Cut or Bite

Knocked Out Baby Tooth

Knocked Out Permanent Tooth

Chipped or Broken Baby Tooth

Chipped or Broken Permanent Tooth

Possible Broken Jaw

Orthodontic Emergencies

24-hour Emergency Care

Leaving issues untreated or delaying treatment can contribute to poor oral health and other serious health issues. The sooner you seek evaluation at our office, the better the chance of avoiding more extensive dental treatments and the faster your child will be back to their smiling, happy, active self.

Check for decay, discoloration, and cracking or food debris on the culprit tooth. Please provide us with as much detail as possible, when calling.

• When does the tooth hurt?
• Does it hurt when chewing?
• Is the tooth cracked or broken?
• Is the gum tissue red, bleeding, or swollen?
• Is the pain spontaneous and keeping them up at night?

Answers to these questions allow your pediatric dentist to give a more accurate diagnosis.

Apply cold ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. Often, there is no need for further treatment, but if bleeding cannot be controlled by simple pressure, call a doctor or go to the emergency room. Often these tissue cuts and bites resolve and disappear in a matter of 10-14 days.

Contact your pediatric dentist during business hours. Baby teeth are not re-implanted.

Control any bleeding by applying pressure with a gauze pad or clean washcloth. Call your child’s dentist and schedule an exam as soon as possible. It is important to evaluate the health of the surrounding teeth and gums. This is not usually an emergency, and in most cases, no treatment is necessary.

If possible, find the tooth. Time is of the essence for these emergencies, and your pediatric dentist should see the child WITHIN 1 HOUR for best chance of success. Hold the tooth by the crown, not by the root. Do not scrub the tooth, simply run it under water. If tooth is in one piece, attempt to reinsert it in the socket. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk until you can see your dentist. If unable to come to the dental office, go to the nearest emergency room.

Contact your pediatric dentist during business hours.

Contact your pediatric dentist. Taking appropriate steps early can prevent infection and reduce the need for extensive dental treatment. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Do not move the jaw. Keep it in a relaxed position and go to the nearest hospital emergency room.

If there is a loose bracket that is irritating the lips or gums, attempt to remove the bracket with a tweezers and place it in an envelope. If there is a loose wire sticking into he cheek, see if you can place it into the tube in the back of mouth or cut it with a cuticle clipper.

The phone number to contact Little Star Pediatric Dentistry’s 24-hour emergency care is (858) 519-6222. A voicemail paging service is available to contact the Doctor on call.