Pediatric Patients

Bosma Dental is a family practice that is focused on the life-long health and wellness of our patients. 

 

 

From their pediatric rotations in dental school and throughout their careers, Drs. Bosma have been seeing and treating children since the beginning.  Not all young patients are candidates for our practice as some patients who have extensive needs can only be treated in specialized settings.  In such cases, we have a network of specialists that we refer to when appropriate.  Aside from those types of situations, children are a welcome part of our practice!

 

As general practitioners, who see and treat complex adult dental problems, Drs. Bosma recognize which problems in the adult population are ones that  begin early in childhood.  It is our goal to prevent and correct problems at their root cause whenever possible, rather than simply treating the symptoms.  We know that one day, our pediatric patients will become our adult patients.  This drives us to continually pursue the latest research and training in order to provide our patients across the age spectrum with the best long-term, healthy and stable dental outcomes.  

 

Our little patients are all different and unique.  We enjoy getting to know them in a warm, fun environment.  We have Nitrous Oxide (laughing gas) for our more nervous patients and iPads overhead for Netflix, Disney Plus and other apps for our patients' viewing pleasure.  Most children do well in the dental chair if they have had prior, enjoyable experiences.  We encourage parents to prepare their child by being positive about their child's dental visits.  Some parents may have their own anxiety about the dentist and must be very careful not convey that to their child.  We advise that parents stay away from using words like pain, hurt, pinch, scared and other such words with negative connotations.  Instead, we recommend preparing for the dental experience by saying things like, you will see, hear, feel and learn new things.   You may even smell or taste new things.  Your teeth will be clean and healthy.  The doctors explain all procedures in a child-oriented manner so the child can understand at an age-appropriate level what is going on during procedures.

 

Primary teeth are slightly different than adult teeth, the care we provide is tailored to that.  Growth and development in young children is a very important area that we assess.  We provide tools for intervention and guidance when we see a deficiency.  The implications for lack of proper growth in the jaws can significantly impact the health and stability of the dental-facial structures as well the general health of our patients for a lifetime.  

 

Below are some examples of pediatric-specific types of treatment done at Bosma Dental. 

 

Dental Treatment For Primary Teeth

Nerve treatment

When a primary tooth is damaged, from decay or trauma, the nerve can become affected.  Primary teeth are important for speech, space maintenance and function.  If the nerve of a primary tooth is affected, we take all or part of the nerve out and the tooth can remain in place without becoming infected until it is ready to fall out naturally.  

Pediatric crowns

When a baby tooth has been affected by decay on many surfaces, a filling restoration is not adequate to keep the tooth from breaking prematurely.  A stainless steel crown can be placed on the baby tooth to reinforce and protect it until the permanent tooth is ready to come in.  The stainless steel crown is fitted and cemented in the same appointment and does not need to be fabricated by a lab like a crown on an a permanent tooth would be.

Space maintenance

If a primary tooth is lost prematurely, the space can close leaving the permanent tooth impacted in the bone due to lack of space for eruption into the arch.  This situation will cause a very complicated orthodontic problem in the future.  In the above picture, you can see an x-ray of space maintainer placed at Bosma Dental after a primary tooth had to be extracted early.  The space maintainer is now ready to be removed as the permanent tooth has erupted into the arch with plenty of space.  The photo below is what space maintainer looks like in the mouth of one of our patients.


Growth and Development


An ideal smile in a young child's mouth should be full of spaces between the baby teeth.  Many children do not have those spaces today because the midface and lower jaw complex is not growing properly.  This results in crowding, impacted teeth, need for removal of healthy adult teeth, gummy smiles, deficient profiles (aka lack of a square jawline), and a myriad of orthodontic problems in the adult dentition.   There is much research and investigation underway as to why this is happening.  Drs. Bosma are asking the why and following the research.  We know that the lack of growth in our jaws is a modern problem because our pre-industrial ancestors did not suffer from "crooked teeth".  When there is space in the arch, the teeth naturally come in straight.  Seeing the problems in our adult patients that have been treated for the symptoms of small jaws rather than addressing them at the root cause led the doctors to pursue this early type of interceptive treatment for their own children and for their young patients who are on a poor growth trajectory.

  

 Ensuring adequate growth of the dental arches is not just about straight teeth, it also affects the upper airway.  The end of the mouth is the beginning of the airway.  The upper airway is a collapsible area that is affected by the anatomy of the surrounding structures and how much soft tissue is present.  Arches that are constricted do not allow the soft tissues in the pharynx (back of the mouth) to spread out.  The soft palate tends to grow downward and the tonsillar pillars are narrower.  The tongue volume increases  in the back of the mouth when the oral cavity is smaller than ideal.   The resulting small space in the upper airway, among other things, leads to mouth breathing rather than the desirable nasal breathing.  As a result, the face continues to develop poorly due to loss of muscle stimulation from the strongest muscle inside the mouth, the tongue. It is a self-propagating cycle that can lead to poor growth into adulthood.  This is especially troublesome when children go to sleep as these structures are soft and collapse during deep sleep.  Snoring, heavy breathing, frequent waking, restless sleep, tooth grinding are all signs that there may be a sleep related breathing disorder that does not allow kids to stay in deep, restful sleep.  Their bodies go through microarousals to keep their airways open throughout the night.  Lack of restorative sleep night after night can cause a slew of problems in children and can follow them into adulthood.  Correcting this arch growth problem becomes harder and more invasive to do as patients get older and the growth potential decreases over time.  

 

 

 The photos below show printed models of before and after the guided growth treatment.  This is a difference of approximately 6 months without any brackets or orthodontic movement of the teeth.

 

More example cases below

 

 

 

 

Early intervention and expansion therapy

The photo on the left is what most people would expect a child's smile with primary teeth to look like.  However, permanent teeth are much larger than primary teeth and there will be a lack of space in the arches for them to erupt.  Lack of space in the arches is the cause of "crooked teeth".  The photo on the right is what a child's smile with primary teeth should actually look like.  In this scenario, the permanent teeth will come into the arch with plenty of space.  This prevents a myriad of problems.   Moving a patient from the left photo to the photo on the right is done reliably and relatively easily in the early ages but becomes much more difficult and invasive as the child gets older and growth potential slows down.

(This case of guided growth intervention was done at Bosma Dental)

 

 

Above is an example of a nine year old patient at Bosma Dental who had early intervention therapy.  The patient had severe lower crowding because his arches were not growing properly.  Within a span of several months, the arch on the left looks like the arch on the right.  The teeth have not been bracketed with any type of orthodontic appliances.  This is simply growth guidance allowing more bone to accommodate the teeth. More importantly, the amount of space available for the tongue has increased.  

This is another patient at Bosma Dental that had early intervention.  With the expansion of the hard palate, the angle between the uvula and soft palate has increased over the course of several months allowing for more space in the upper airway.  The tonsils are still present but they are much farther apart in the right photo.

Here is a case from Bosma Dental where one of our  5 year old pediatric patients had a lack of growth in the arches.  With some guidance, in a span of 5-6 months, the arches became larger and the permanent teeth came in straight.  The patient is now on a much better growth trajectory and the remaining permanent teeth will have space to align properly in the arch.  Notice the lack of space for the tongue in the first  picture on the left.  After guided growth and development, the space for the tongue has significantly increased to the picture on the right.  In the next set of photos, the palate has evidently increased in size and now the tongue has plenty of space to rest on the roof of the mouth.  This change in anatomy and posture helps a mouth breather turn into a nose breather.

Above is another example of a case at Bosma Dental where a patient's arches were not developing properly and there was an excessive amount of crowding.  This patient was also tongue tied and needed a release.  Dr. Bosma worked with a carefully selected surgeon to plan the case.  The expansion was done at Bosma Dental prior to surgery.  With more space in the arches, the tongue is now able to spread out in the mouth and has space to rest in the palate.  The patient went through tongue exercises and stretches prior to surgery and after the release surgery.  The stretching exercises kept the released frenum from scarring, preventing a tighter tether to the floor of the mouth.  After a successful release with a highly trained surgeon, and rehab exercises, the patient is now able to keep his tongue in the roof of his mouth which pulls it out of the airway and supports the newly developed arches.  This type of developed anatomy and tongue posture allows the patient to turn from a mouth breather to a nasal breather.

Another example of early intervention expansion where the primary teeth are very close together.  The larger permanent teeth do not have space in the bone to erupt into the arches.  Both arches were expanded and the space increase is evident in the right column.  Once the permanent teeth fully erupt into spacious arches, residual minor rotations are easily corrected.  Often times these rotations correct themselves with enough space and proper tongue posture.

This is a case at Bosma Dental in which a severe underbite was reversed in a four year old patient over the course of a few months.  Left untreated, this patient would most likely have needed surgery in early adulthood to bring the upper jaw forward and lower jaw back.  This patient is now on a much healthier growth trajectory.

This is Drs. Bosma's daughter.  She had some crowding in her lower primary teeth as seen in the above left photos.  She was treated with early intervention growth guidance when she was four years old.  Now, as a six year old, she has a bright and broad smile that will accommodate her larger permanent teeth and is set on a more ideal growth trajectory.  

Dr. Bosma noticed this patient was growing asymmetrically.  On the left you can see the underbite, on the right, this has been corrected with guided growth interventions.  This growth trajectory is less predictable to treat in the adult dentition.  After treatment, her arches are larger, uniform and the upper and lower arches are set up to grow in harmony with each other.