Jedi, 2008 and 2026

How Do Pediatric Dentists Care for a Child’s Smile?

In communities like ours in West Los Angeles, parents are deeply engaged in their children’s health and education. They want to understand their options and to be part of the decision-making process. I value this partnership deeply, because the best treatment plans are developed when healthcare providers and families work together with a shared understanding of a child’s needs and goals.

As an educator at the University of Southern California (USC) and a fellow of the American Acadmy of Pediatric Dentistry (AAPD), my conversations with parents and my clinical practices are rooted in what we call evidence-based care, a concept advanced by physician David Sackett. He explained it as the integration of scientific evidence, clinical expertise, and the values of the patient and family. This last pilar that Dr. Sackett described is the most important one because every family has its uniqe structure, needs and desires. These values play a major part in decisions making and treatment planning.

 

A New Way to Visualize Growing Smiles

At the same time, dentistry continues to evolve. New technologies such as digital scanning, 3D visualization, and digital design are giving clinicians new ways to study developing smiles with remarkable clarity. However, although these technologies are becoming mainstream in general dentistry, they have yet to truly change pediatric dental care.

As a true advocate for child wellbeing, I am passionate about introducing new technologies to our profession in ways that honor kids and make their dental visits smoother and easier. I also believe in the increased educational value that these technologies can offer our families. When parents, and kids, can understand what we are seeing, they can better relate to the findings and make clearer decisions on how they would like to move through any needed care. Communication builds trust and improves the whole family’s overall experience.

How Do Healthcare Practitioners Adopt New Technologies?

The sociologist Everett Rogers described how innovations are adopted by practitioners over time. Not every clinician will jump on board from the start. New ideas begin with early adopters and, as evidence grows, become part of everyday care.

• Innovators – a small group of clinicians who explore new technologies early and carefully
• Early adopters – experienced providers who begin using these approaches thoughtfully in practice
• Early majority – a larger group that adopts the technology as evidence and experience grow
• Late majority – clinicians who adopt once the approach becomes widely accepted and well-established
• Laggards – those who prefer to wait until a method has been used successfully for many years

This gradual process helps ensure that new technologies are studied, refined, and used responsibly before becoming part of routine care. Digital dentistry is currently moving through these stages, as clinicians continue to learn, evaluate, and integrate these tools in ways that best serve their patients.

Whole-Child Health

If I were to describe the philosophy of our practice, Smiles Pediatric Dentistry & Orthodontics, the first thing that comes to mind is our ture belief in wellness as a birthright. Our goal as healthcare professionals needs to be focused on the belief of wellness rather than illness. Health researchers describe this perspective as the idea of “Salutogenesis”, a model of care focused on supporting health, resilience, and wellbeing described by medical sociologist, Aaron Antonovsky in the late seventies. The word comes from Latin:

• “salus” = health
• “genesis” = origin

This translates to: “The origin of health” or “How health is created.”

In pediatric dentistry, this means looking beyond the teeth and caring for the whole child, recognizing that oral wellness is and essential part of total body wellbeing. A successful outcome is not just a restored tooth, but a child who feels comfortable in the dental setting and grows into an adult that values their oral health.

Where Innovation Meets Evidence, And Evidence Meets Patient care

Every major advancement in dentistry begins as an innovation. Today, digital dentistry is part of that same continuum. Innovation initiates progress, and evidence follows. Within this evolution, and in alignment with Dr. Sackett’s evidence-based model, we must create space for patient and family values.

Clinical data, no matter how robust, must be interpreted within the context of the individual. Decisions about one’s body ultimately belong to the patient—or to their parents, in the case of children. Over time, research helps refine how and when innovations are best applied, guiding us toward more thoughtful and effective care.

Technology, when used with intention, should support the principles of salutogenesis—promoting comfort, reducing stress, and fostering a sense of wellbeing during the dental experience. Because in the end, it is never just about the technology. It is about the child.

The Goal Has Always Been the Same

Despite all advances, the goal remains the same: gentle, thoughtful care that supports both the health and confidence of every child and teen that we are priviliaged to care for.

Goals for every child and teen visiting Smiles:

– comfort and emotional experience
– long-term oral health
– supported growth and development
– family involvement in care

When innovation, evidence-based care, and whole-child health come together, they create meaningful, lasting outcomes in addition to changing the future dental outlook for an entire population.

Give your child a comfortable, positive dental experience with care designed around their growth, health, and confidence at Smiles Pediatric Dentistry & Orthodontics.

Contact us today to schedule your child’s visit.

Knowledge Welcomes Confidence and Empowerment

As a pediatric dentist, I have received many calls from frantic parents whose children have bumped their teeth at home, at school, or while playing sport. My heart goes out to the parents of toddlers who turn their heads for a split second only to hear a loud thud followed by explosive cries. I think of parents receiving a call from school informing them that their child has had an accident on the playground. And of course, the young athletes in the middle of a game who get hit by balls, elbows, or even feet.

The purpose of writing this is primarily to reassure parents that they are doing their best. As much as we love and protect our children, they will experience their own journeys. Our role is to remain informed, supportive, and calm and to trust in modern, evidence-based dental care when it is needed most.

My hope is that this blog serves as a quick, practical reference for what to do during a dental trauma emergency: how to respond, how to comfort your child, and how to understand the appropriate timeframe for management based on decades of scientific research that have shaped today’s state-of-the-art pediatric dentistry.

Most importantly, I hope it offers reassurance in that our children are resilient, and with, gentle and attentive care, they can return to oral health and well-being.

How To Manage Dental Injuries 

In moments of trauma, parents are suddenly confronted with uncertainty. They are not only trying to comfort their child but are also searching for answers. The good news is that there are a few key actions that significantly improve outcomes. These steps are simple, easy to remember, and can be implemented immediately.

Emergency calls to our office at Smiles Pediatric Dentistry & Orthodontics are always given priority. These calls are essential in guiding parents in real time. Immediate communication allows us to assess the situation, determine the urgency, and provide clear next steps.

Teledentistry has become an especially valuable tool in these circumstances. Virtual assessment allows us to evaluate kids quickly wherever they are, guide first-line management, and coordinate appropriate follow-up care. Just as importantly, it offers reassurance at a time of uncertainty. Parents and children benefit from knowing they are supported with presence, knowledge, and compassion.

Many dental trauma incidents can be managed outside of the emergency room. When a call comes in, one of the first decisions we review is whether medical evaluation is necessary. If we determine that the injury was purely dental in nature, we efficiently shift gear into the prompt management of the trauma to help ensure the most positive outcome.

If there is concern for head injury, loss of consciousness, nausea, dizziness, or significant soft tissue trauma, medical care must come first because every child’s overall well-being always takes priority. When children do present to the emergency room, medical triage appropriately takes priority. Soft tissue injuries may require suturing. Imaging and neurological evaluation take time. These essential steps can inadvertently delay time-sensitive dental intervention. However, early dental triage, even if coordinated alongside medical care, is both possible and beneficial.

The Evidence Behind Modern Dental Trauma Care

All of us in the pediatric dental profession hold a special place in our hearts for the father of modern dental traumatology, Dr. Jens Andreasen. His evidence-based work, spanning more than six decades, has not only stood the test of time but continues to serve as the foundation for how we diagnose, triage, and manage dental trauma today.

As a child who personally experienced dental trauma, Dr. Andreasen new firsthand what a child goes through when they deal with a dental injury. He dedicated his career to understanding what happens to injured teeth, and more importantly, how to save them. His research taught us something powerful: when teeth are handled properly and treated quickly, they can often be preserved. He helped establish the timeframes that matter, the safest ways to stabilize injured teeth, and why careful follow-up is essential to ensure long-term healing. Much of what we know today about managing knocked-out, displaced, or fractured teeth comes directly from his life’s work.

The International Association of Dental Traumatology (IADT) guidelines are grounded in this body of evidence and have been adopted by the American Academy of Pediatric Dentistry (AAPD). When these principles are followed, outcomes improve significantly.

Primary vs Permanent Tooth Injuries: Why Management Differs

Another important distinction we make during every trauma call is the age of the child and whether the injured tooth is primary (baby) or permanent. This information is important because it not only helps guide parents and children through the experience in an age-appropriate way, but it also directly influences how the injury is managed. Treatment decisions differ significantly depending on whether the affected tooth is primary or permanent.

Clinical management must consider anatomy, stage of root development, and long-term prognosis. It is important to understand that certain interventions that are necessary for permanent teeth may not be appropriate for primary teeth. Protecting the developing permanent tooth is always a priority when managing trauma to primary teeth.

Types of Dental Injuries:

Dental trauma can present in diverse ways, depending on how the tooth is injured:

• Enamel fractures – minimal crown fractures involving only the outer white layer of the tooth.
• Enamel-dentin fractures – moderate crown fractures that extend deeper into the tooth structure but do not expose the nerve.
• Complicated crown fractures – fractures that involve pulp (nerve) exposure and often require more urgent intervention.
• Crown-root fractures – fractures that extend below the gumline, often at an angle, and may affect both the visible portion of the tooth and the root.
• Luxation injuries – injuries in which a tooth is displaced from its normal position in varying degrees or directions. These include concussion (tender but not loose), subluxation (loose but not displaced), extrusion (partially pulled out), lateral luxation (pushed sideways), and intrusion (pushed deeper into the socket).
• Avulsion – a tooth that has been completely knocked out of the mouth.

 

How Are Dental Injuries Managed?

Accurate diagnosis requires careful clinical examination and dental imaging (x-rays) assessment. Once all the information has been gathered, a thoughtful, evidence-based, and age-appropriate plan is followed.

Treatment decisions are guided by:

-The age of the child

-Stage of root development (a brand-new tooth vs one that has been in the mouth for years)
-Presence or absence of pulp (nerve) exposure
-Degree of mobility or displacement
-Dental imaging findings

 

What To Expect for Management of Dental Injuries

Injury Type	Primary Tooth Management	Permanent Tooth Management
Crown fracture (chipped tooth)	Sharp edges are smoothed or the tooth is restored as needed. Pulp (nerve) vitality is monitored over time.	If the fragment is available, it may be reattached. Otherwise restored with bonding. Pulp (nerve) vitality is monitored.
Complicated crown fracture (pulp exposure)	Pulp therapy may be indicated depending on stage of development. Extraction may be considered if prognosis is poor.	Vital pulp therapy preferred in immature teeth. Root canal therapy may be indicated in mature teeth.
Crown-root fracture	Tooth assessed for restorability. Extraction may be required depending on fracture extent.	Requires stabilization and possible root canal or periodontal management depending on fracture depth.
Luxation injury (displaced tooth)	Often managed conservatively. Monitored closely for healing and impact on permanent successor.	Repositioning often indicated. Flexible splinting per IADT guidelines. Long-term pulp (nerve) monitoring is essential.
Avulsion (knocked-out tooth)	Avulsed primary teeth are not replanted. Space management or restorative options may be discussed.	Time-sensitive emergency. Tooth should be replanted immediately when possible. Stabilization required. Root canal therapy often necessary.

 

What Parents Should Do Immediately After Dental Trauma

For any dental injury, try to stay as calm as you can. Comfort and reassure your child, then contact your pediatric dentist as soon as possible. Even injuries that appear minor should be evaluated to ensure proper healing and to prevent long-term complications.

Quick Guide Steps:

1. Gently clean your child’s lips and gums with a clean gauze or cloth.
2. Locate any fractured fragment and store it in water or saline.
3. If a permanent tooth is knocked out, handle it only by the crown, never the root. Try to gently reposition it into the socket and seek immediate care.

5. If you are unable to reposition the tooth, placing it in a “save-a-tooth” kit https://www.saveatooth.com/ or in milk is the next best option.
6. If a primary tooth is knocked out, keep it for dental evaluation but do not attempt to replant it. Primary teeth are not replanted to avoid damage to the underlying developing permanent tooth.
   7. Contact your dentist promptly for evaluation.

What Parents Should Do: Immediate first steps you can take before professional evaluation

Injury Type	What Parents Should Do – Primary (Baby) Tooth	What Parents Should Do – Permanent Tooth
Crown fracture (chipped tooth)	Look for the fragment to bring to your dentist. Store it in water or saline.	Look for the fragment. Store it in water or saline (not milk).
Complicated crown fracture (pulp exposure)	Avoid biting into foods. Avoid hot or cold foods and touching the injured area. If a fragment is present, store it in water or saline.	Avoid biting into foods. Save the fragment in water or saline if available.
Crown-root fracture	Do not manipulate the tooth. Keep your child comfortable. If a fragment is present, store it in water or saline.	Do not manipulate the tooth. Avoid biting on it. If a fragment is present, store it in water or saline.
Luxation injury (displaced tooth)	Do not attempt to reposition at home. Offer soft foods only.	Do not force the tooth back unless instructed. Avoid biting on it.
Avulsion (knocked-out tooth)	Do not replant. Apply gentle pressure with gauze if bleeding. Bring the tooth with you for evaluation.	Pick up the tooth by the crown only. If dirty, gently rinse with milk or saline (do not scrub). Replant immediately if possible or store in milk. Seek care within 60 minutes.

 

The Importance of Follow-Up

Dental trauma management extends beyond the initial treatment. Follow-up evaluations are needed to assess the vitality of the tooth and the continued root integrity. Standard intervals often include assessments at 6–8 weeks, 6 months, and 1 year, with extended monitoring when indicated.

Prevention: The Best Treatment Is Protection

While modern dentistry allows us to manage trauma conservatively and effectively, prevention remains the most powerful intervention.

Recent collaboration between the International Association of Dental Traumatology (IADT) and the American Society of Dentistry (ASD) reflects a shared emphasis on prevention as an integral component of trauma care. This alignment highlights the importance of evidence-based protective strategies for children and adolescents engaged in athletics. With more kids involved in athletics, especially with major athletic events approaching in Los Angeles, protective measures must evolve alongside clinical innovation.

As an active member of the ASD, I remain very focused on streamlined fabrication of sports mouthguards, exploring advancements in digital workflows, material science, and precision 3D fabrication. Custom 3D printed sports guards provide superior fit, comfort, and protection compared to stock alternatives. Studies have proven that when properly fabricated and worn consistently, they significantly reduce the incidence and severity of dental injuries.

When Replacement Is Needed: Innovative Pediatric Solutions:

While prevention remains the most powerful strategy, some injuries result in tooth loss or structural damage that requires restorative intervention.

For very young patients, esthetic options for lost primary incisors were historically limited. In many cases, families were told to simply wait for the permanent teeth to erupt. Today, digital dentistry allows us to offer thoughtful alternatives.

In our practice, we utilize digital workflows to fabricate conservative, esthetic solutions for young patients — including PrintiSmile, a custom-designed 3D printed pediatric anterior restoration.

Unlike traditional removable appliances or aggressive preparations, PrintiSmile allows for:

• Precise digital design
• Minimal intervention
• Age-appropriate esthetics
• Efficient chairside delivery

For children navigating early childhood social development, restoring the appearance of a front tooth can support confidence, speech development, and overall well-being. Digital pediatric dentistry allows us to restore both biology and self-confidence.

Clinical Case: Uncomplicated Crown Fracture in a Teen Athlete

When life presents unexpected challenges, thoughtful care can turn a stressful moment into a positive outcome.

A teen athlete presented with an uncomplicated crown fracture of a maxillary central incisor following trauma. Because he was undergoing Invisalign therapy at the time of injury, his aligner tray was utilized as a precision positioning guide during fragment reattachment.

This allowed accurate adaptation of the rebonded fragment while preserving natural anatomy. The result achieved excellent esthetics with minimal intervention, demonstrating the value of prompt evaluation and conservative treatment planning.

If your child has experienced a chipped, displaced, or knocked-out tooth, contact Smiles Pediatric Dentistry & Orthodontics for expert pediatric dental trauma care. Our team provides treatment to protect your child’s smile and help prevent long-term complications.

Contact us to schedule an appointment or book a consultation through our website.

Frequently Asked Questions About Pediatric Dental Trauma

What should I do if my child knocks out a permanent tooth?

Pick up the tooth by the crown only. Reinsert the tooth immediately into its socket, if possible, or store in milk and seek care within 60 minutes.

Should I replant a baby tooth that was knocked out?

No. Primary teeth should not be replanted due to risk to the developing permanent tooth.

Can a chipped tooth fragment be rebonded?

Yes. If preserved properly in water or saline, many permanent tooth fragments can be successfully rebonded.

How long can a tooth stay out of the mouth?

Prognosis declines significantly after 60 minutes of dry time. Immediate action improves survival.

Does my child need a mouthguard for sports?

Yes. Custom sports mouthguards significantly reduce the incidence and severity of dental injuries.

References

Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth.
International Association of Dental Traumatology (IADT) Guidelines for the Management of Traumatic Dental Injuries.
American Society of Dentistry (ASD) Collaborative Guidance on Trauma Prevention and Protective Fabrication.

How comfort, education, and emotional intelligence shape lifelong dental health

Dentistry for children is far more than a technical procedure. It is a whole-body experience that integrates physical sensation, emotion, memory, and trust. For me, it becomes part of each child’s health story, and I aim wholeheartedly to make that story as easy, joyful, and empowering as possible. This mindset naturally leads to a pursuit of anything that can soften the dental experience and mindfully usher it forward.

In this blog, I set out to write about local anesthesia, often considered the “magic wand” of modern dentistry. Yet as I began writing, I realized that while I am deeply grateful for the technologies we seamlessly integrate at Smiles Pediatric Dentistry & Orthodontics, local anesthesia has never been the centerpiece of care in my practice. Rather, it is one of many tools used thoughtfully to support wellness, safety, and long-term health. I also wanted to express appreciation for the health leaders who paved the way for humane procedures, not only through scientific discovery, but through philosophy.

The First Breakthrough: Cocaine and Local Anesthesia

In 1884, Carl Koller, an ophthalmologist, demonstrated that cocaine could block nerve sensation when applied locally. Although his work focused on eye surgery, the implications were immediate and profound. Dentistry quickly recognized the potential. For the first time, pain could be controlled locally without rendering the patient unconscious. This discovery marked the beginning of modern, humane dentistry. However, cocaine’s toxicity and addictive potential made it unsuitable for widespread, long-term use.

The True Foundation of Modern Dental Anesthesia: Procaine (Novocaine)

In 1905, Alfred Einhorn synthesized procaine, later marketed as Novocaine. This moment is arguably the true birth of modern dental anesthesia.

Procaine was significantly safer, non-addictive, predictable, and effective for dental procedures.

Novocaine allowed dentistry to move out of an era of endurance and into an era of intentional comfort. For the first time, pain control could be integrated thoughtfully into routine dental care, including care for children.

An Important Perspective: Anesthesia as a Tool, not a Philosophy

Even as local anesthesia transformed dentistry, early pediatric dental pioneers such as Dr. Evangeline Jordan emphasized something essential: pain control alone does not create gentle care. She focused on prevention, education, emotional safety, and trust. She understood that a child’s experience of dentistry is shaped not only by sensation, but by meaning and by what follows afterward. This distinction remains essential today.

Why This History Matters Today

Local anesthesia is one of the greatest gifts to dentistry. It allowed care to become humane, precise, and ethical. But it was never meant to replace communication, education, emotional intelligence, or respect for a child’s nervous system.

Why Local Anesthesia Can Be Challenging for Children

Although local anesthesia is safe and effective, it can introduce challenges for pediatric patients, including anticipatory anxiety, fear of numbness, prolonged post-operative sensations, and lip or cheek biting injuries following lower-arch procedures. When poorly timed or insufficiently supported, these experiences can shape a child’s perception of dentistry for life.

A Philosophical Alignment with Dr. Evangeline Jordan

I agree deeply with Dr. Jordan’s philosophy and find that it continues to resonate with today’s approach to child oral care, as well as with current best practices outlined by the American Academy of Pediatric Dentistry (AAPD).

 

Local anesthesia is a wonderful and indispensable tool, but we would all still prefer complete health over a disease process that requires intervention, no matter how gentle that intervention may be. Dr. Jordan did not promote aggressive procedural completion, nor did she center anesthesia as the foundation of care. Our primary goal must be health preservation, practicing the concept of salutogenesis, coined by sociologist Aaron Antonovsky. Rather than asking “What causes illness?” salutogenesis asks, “What creates health?”

Education as Care: Empowering the Child 

As pediatric dentists, we are stewards of oral health education and empowerment. This role may be even more important than treating dental disease, because it promotes the end of the cycle of unwellness. When children understand why something is needed in an age-appropriate way, are encouraged to notice how their bodies feel, and are invited to communicate their needs, this fosters emotional intelligence — something the age of artificial intelligence can never replace.

Education and communication must also extend to parents before care even begins. Well-intending parents may unintentionally add an emotional layer by asking, “Does it hurt?” or saying, “I know this is uncomfortable.” These statements can weave a parent’s own dental experiences into their child’s perception of the visit.

I’ve learned to speak with parents thoughtfully before rendering any treatment. While my team engages the child with prizes, movies, and conversation, I take time to explain what is needed, what options exist, what reactions they might notice, and how care can be delivered successfully. I also clarify what I can reasonably accomplish, when we might pause, and when a different modality, including further sedation options, may be more appropriate.

After many years in pediatric dentistry, I have learned this essential truth: when we unite with parents around the goal of loving a child and giving them the best experience possible, everything flows more naturally.

Once parents are comfortable, my true client — the child — can be informed gently and age-appropriately about what to expect, how to communicate their needs, and how to participate in their own care. Above all, they receive a generous sprinkling of honoring and love to ensure safety and trust.

The Evolution of Gentle Anesthesia Delivery

STA Single Tooth Anethesia System

Soan Electronic Dental Anesthesia Device

Since opening in 2008, Smiles Pediatric Dentistry & Orthodontics has used computerized anesthesia delivery systems to improve comfort. Early adoption of single-tooth anesthesia technology allowed us to deliver controlled, gentle, and ultra-localized anesthetic. Today, the SOAN unit continues this evolution with enhanced precision, ergonomics, and thoughtful design. These devices not only feel better, but they also look better and often appear non-threatening to children.

The Role of Exceptional Topical Anesthesia

Topical anesthesia is often underestimated. When applied correctly with time, isolation, and intention, it can significantly reduce discomfort and support minor procedures, sometimes reducing the need for injectable solutions. While topical, these gels must still be respected in terms of dosage and application. I truly find them indispensable and make a point to apply them personally, rather than delegate their application to team members.

I like to place the topical exactly where I want it to work and am very careful to avoid it spreading in the child’s mouth. I do this by covering the area with a slightly moistened gauze. This allows the gel to work effectively and remain localized, since tasting topical anesthetic does not create the pleasant experience we aim to provide.

 

Moistening the gauze allows for gentle removal and helps prevent it from adhering to the delicate oral mucosa. Topical anesthesia is especially wonderful for removing exfoliating primary teeth with utter ease and delight for children, and it is often one of the most rewarding requests our young clients make, because it ensures a visit from the tooth fairy.

 

The Solea Laser and the Anesthesia-Free Option

Solea laser technology has allowed many dental treatments to be performed without needles, numbness, or drills. The pulsing of the laser acts on the pain-gate mechanism, dramatically reducing uncomfortable sensations. That said, comfort requires thoughtful planning, not simply the goal of avoiding anesthesia. Compassion and communication remain the cornerstones of a comfortable dental visit.

Sedation as Part of a Thoughtful Spectrum 

True customization includes sedation options, when appropriate. These range from nitrous oxide and oxygen to oral sedation and deep (intravenous) sedation or general anesthesia for complex cases. The goal is not avoidance of anesthesia or sedation, but the right support at the right time for the right child.

The Stewardship Responsibility 

Pediatric dentists are stewards of how children perceive healthcare for life. A single overwhelming experience can leave a lasting imprint. Our responsibility extends beyond completing treatment to protecting trust, confidence, and emotional well-being. Gentle dentistry is about doing what is right — thoughtfully, compassionately, and through a wellness-centered lens. By integrating education, emotional intelligence, modern technology, individualized anesthesia planning, and when appropriate, sedation, we support not only oral health, but lifelong well-being.

“When to Nudge Mother Nature” as a Pediatric Dentist

As an early oral healthcare provider, I ask myself with every family encounter if I offered  guidance and value, whether I over- or under-recommended pediatric dental and early orthodontic care, and if the family fully understood my recommendations or if I could do more to allow the conversation to fully resonate. This inner dialogue stems from a deep desire to do good and to honor the oath and responsibility of health caregiving. After years of practicing, I have wisely come to realize that compassionate care is far from a one-size-fits-all model. It is beyond individualized care. It is an in-depth, on-going and ever-evolving conversation that is constantly remodeling based on new parameters, growth trajectories and general family life. In simple terms, it is a day-by-day adventure.

Do we have to do anything?

No parent wants to put their child through unnecessary procedures. Operative and restorative medical and dental treatments are a considerable experience to undergo for a family. As wise stewards of the trajectory of each child’s lifetime dental experiences, we, pediatric dentists have much to consider.

Since pediatric dentistry is truly about health, then the next evolution isn’t simply better tools. It is earlier presence, gentler guidance, and a shift from fixing problems to organizing development. The tenant of “do no harm” is really at the core of this matter. There are times when this translates to “let well enough be”. Other times, it means “clear the path now to allow the easier path to unfold”

Whole-Body Pediatric Dental Health

I recently had the honor of taking on the role of Chapter 2 liaison for The American Academy of Pediatrics (AAP) at the California Society of Pediatric Dentistry (CSPD). This role called to me because it bridges the professions of pediatric dentistry and pediatric medicine, and studies ways to enhance collaborations. As an educator at Herman Ostrow School of Dentistry of USC, conversations with residents often delve into the concept of whole-body health and how we can hold hands with our medical colleagues to provide a comprehensive approach to general wellness. In my mind (and heart), the compass constantly points to small, micro changes at earlier timelines. Guiding new parents on infant oral health is at the core of this dialogue.

When pediatric dental care begins

When I welcomed my first born, my beautiful daughter, Isabel Ida Haddad, I entered into motherhood as a right of passage. It was as if the whole reason for my being was suddenly beautifully validated. I found a calm and nurturing space at UCLA’s Birth Place. with a warm group of new mothers coming together to learn about breastfeeding and infant care. I was treading gently on these new grounds but felt that new mothers like me, were often overwhelmed with information and instructions. All of us were fully committed, but many desperately needed support systems. When the group heard of my profession, they began asking questions about infant oral care and were most appreciative for the information that I was able to provide. Through this group, I not only gained new families at Smiles, I realized that new parents are receptive to oral care information early on and enriched my life with life-long connections that I truly cherish.

The Opportunities Pediatric Dentists Don’t Talk About Enough

New parents are full of questions:

• When should I start caring for my baby’s mouth?
• Is teething problematic or normal?
• What happens if my toddler falls and hits a tooth?
• When do habits become harmful?
• When do we actually need to see a dentist?

Too often, there is no clear entry point for these questions. Families are left to Google, social media, or wait until something feels “wrong enough.” By the time they arrive at a dental office, dentistry becomes reactive instead of nurturing or preventative.

From “Risk-assessment/management” to “Path clearing”

I prefer to practice dentistry from a lens of health rather than risk predictions. I value being a mindful observer of health and of the dental development process. Like carefully tending a growing garden, there are times that we need to prune, trim and replant to allow for true balance and beauty to manifest. In these instances, I see myself as a path clearer and someone who helps growing systems find their way back to natural harmony, when development veers off course.

The specialties of pediatric dentistry and early orthodontics need not alarm families into action, nor impose recommendations as dogma. We need to be storytellers of development. Furthermore, we need to be mindful that the story of growth is ever evolving. Our profession needs to support biology, compassion, and trust.

Honoring human biology

Life’s pace is rapidly excellerating. We can certainly all resonate with how fast everything is moving in our day-to-day lives. Everything is expected sooner and demands more efficiency. To hold thoughtfulness is a skill that requires fostering in today’s world. Like physical activity, the mind needs daily training to slow down and take in the moment. The undeniable advances in AI and its projected path in the next few years, cannot be overlooked. We can, indeed, find solutions with a click of a button, yet we must remember that we still remain biologically human. This is a tender time for humanity. Finding the balance between what we want our bodies to do and what they are biologically capable of, all while maintinaing a positive and healthy state of mind requires pause, gentleness, and wisdom.

 

The future paths coincide

Imagine a world where families receive:

• Collaborative, “whole-istic” anticipatory guidance in the first year of life
• Simple at-home testing kits that help customize the fostering of well-being
• Coaching on habits, feeding, eruption, and oral hygiene
• Matching with caring providers (both pediatric medical and pediatric dental doctors)
• Virtual (human and AI-empowered) points of service
• Reassurance after a fall or dental trauma
• Facilitation when in-person care is needed

Home-based, virtual care matters

In 2019, we reshaped our lives due to the global pandemic. One of the most challenging experiences of modern times also brought forward new ways of living, communication, expectation and innovation. Because people couldn’t meet in person, new ways of connecting quickly began emerging. Many of these modalities quickly became mainstream as meetings moved to online platforms and telemedicine surged.

At Smiles, we started with asking families to text/email photos of their children’s mouths and then moved to teledentistry communications. I personally found this type of communication to be so helpful in triaging emergencies and guiding parents on how to handle bumps, falls and incidental dental occurrences. At the same time, this new era of dental communications needed to be organized, structured and validated in terms of transparency, legality and expectations in order to honor both providers and receivers. Once, this structuring formed a solid foundation, the true power of virtual communications began to really shine.

 

Where pediatric virtual care shines

A virtual conversation in the convenience of a family’s home has the potential to become:

• A first touchpoint for infant oral health
• A trusted guide for new parents
• A calm, accessible place for questions before concern escalates
• A reassuring “baby step” to the first dental visit, which helps set expectations
• A beautiful bridge between home and in-office care, not a replacement for it

Los Angeles is a vast metropolis with much to offer, but supportive, in-persons communities may not be readily accessible to everyone. For example: Mothers recuperating from post-partum challenges may not be able to participate in such meetings. In such instances, a virtual offering is not only supportive, but also essential. An encounter like this promotes health, compassion nurturing, and whole-body care before any treatment even comes into question.

What about early orthodontics?

Every day at Smiles, we get to see firsthand how collaborative pediatric dental care and early orthodontic guidance change lives. Our collaborative approach is based on integrating both specialties into combined, comprehensive, and time-saving visits.

• Early arch development reduces later complexity
• Early education builds lifelong trust
• Early intervention can be gentle, not invasive
• Yes, kids with loose baby teeth can start care. In fact, it is a good time to start orthodontics because one of the main goals of early care is to facilitate the eruption of all permanent teeth.

Pediatric dentistry should function as an ecosystem

• Virtual guidance
• Home-based education
• In-office excellence
• Biological respect
• Family-centered decision-making

If we are to promote oral health, we need to plan on arriving earlier and supporting families where they live. We need to focus on guiding development rather than reacting to breakdown. And we need to shift from thinking that we are here to fix dental problems to believing that we are here to support nature, organize growth and clear paths. The tools are already here. It is up to us to use them with intention.

Charting the path:

From the very beginning of my career in pediatric dentistry and early orthodontics, I’ve given much thought to how I can elevate kids’ dental experiences and make their oral health encounters softer, more educational, and super comfortable. I’d often ask myself: What if kids could be treated with fully customized, esthetic dental solutions just like adults can? Why do we cut kids short when it comes to implementing dental technology? And how will kids react to elevated dental care?

This deep desire to offer better solutions to my child clients led me down the path of innovation. If a solution wasn’t present, why not create it? Dental technology is an investment. One based on the betterment of care and an increase in comfort that is essential for a positive dental experience. And, yes, most kids do replace all of their primary teeth with permanent ones. But this doesn’t happen overnight. I see many teenagers who still have primary molars at 14 and 15 years of age.

When I embarked on mastering 3D printing and CAD/CAM dentistry, I knew that I would finally be able to offer custom-designed, child-friendly, esthetic and restorative pediatric dental care. My excitement was limitless as I began redesigning traditional pediatric appliances for 3D printing possibilities. These innovations required testing, developing, and diligent follow up. It is now time to start sharing them. I would like to proudly introduce “SmileKeeper ^TM”

What is a space maintainer?

As much as we honor oral and dental well-being, there are times when a child loses a baby tooth earlier than nature intended, whether from a cavity, an accident, or an extraction. It is in these instances that the importance of primary teeth is truly highlighted. Because, if the site of the lost primary molar is not well-preserved, something subtle but important begins to happen in the child’s mouth:

• Neighboring teeth drift.
• Space begins to close.
• The room reserved for an incoming permanent tooth narrows.

Traditionally, pediatric dentists place a metal band-and-loop space maintainer to hold this precious space open. The bands sit on an adjacent molar and the loop extends to touch the tooth further forward. The appliances require an impression and lab fabrication. More recently, band and loop kits became available on the market. These kits offer the great advantage of chair-side asembly, skipping lab fabrication, saving valuable time and mutiple appointments for the child ad their parent. However, they are far from custom-fit. The best size is chosen from the kit and adjusted as best as possible.

But today’s kids get more:

• More comfort
• More biocompatibility
• More beauty
• More gentleness
• More modern dentistry

What is “SmileKeeper ^TM” ?

SmileKeeper is a next-generation, 3D printed, child-friendly space maintainer designed to protect smiles without the bulk, discomfort, or frustration of older technology. It is esthetic, completely metal-free and can even replace the lost tooth. It is growth-friendly and easily adjustable to allow for dental arch development. It is also easy to remove with a simple polishing.

Why “SmileKeeper ^TM” Was Born: A Better Path for Kids

For years, I watched children:

• Bite their cheeks around metal wires
• Struggle to clean around a large band
• Get food trapped
• Come in with loose appliances
• Ask about metal bands

Parents would often ask: “Is there something more comfortable? More modern? There really wasn’t much. So, I created it. “SmileKeeper ^TM” is pediatric dentistry evolving toward comfort and precision.

Smile Keeper is the result of:

• Elevated pediatric dentistry
• 3D printing innovation
• CAD/CAM design
• Digital oral scans
• And years of seeing what truly supports children

What Makes “SmileKeeper ^TM” Different?

1. No Metal, No Wires

Smile Keeper is designed digitally and custom printed for your child without metal bands or poking wires. The design is a monolithic design so the appliance is entirely printed in one piece our of a liquid resin that is FDA approved for oral care.

2. Ultra-Light, Ultra-Comfortable and Completely Esthetic

Kids forget it’s in their mouth, which is exactly the goal.

3. 3D Precision Fit

Digital scans mean “SmileKeeper ^TM” is designed for a perfect fit for your child’s unique anatomy using a precise digital impression or oral scan.

4. Gentle on Gums + Easier to Clean

• Smooth contours.
• No sharp edges.
• Better hygiene.
• Less plaque.

5. Beautiful, Invisible Design

• Barely visible.
• Blends into the smile.
• Perfect for photos, confidence, and comfort.

6. Fewer Appointments

Because it is prefabricated, SmileKeeper is ready to go before any tooth has been removed. This is the magic of digital dentistry and CAD/CAM designs. In addion, the apliances fits right away, so there’s less need for returns or troubleshooting.

Who Is “SmileKeeper ^TM” For?

Smile Keeper is ideal for children who lost a baby molar early (early childhood caries or trauma) and kids who struggle with traditional metal appliances when space needs to be preserved gently and beautifully,

Designed With Heart, Printed With Precision

“SmileKeeper ^TM” is more than a device. It is part of the mission I’ve carried for two decades to bring leading-edge digital dentistry to children in the gentlest, most joyful way possible. When a child sits in my chair, I see:

• Their future smile
• Their confidence
• Their wellbeing
• The ripple effect of early, positive dental experiences. “SmileKeeper ^TM” protects that future comfortably and beautifully.

A New Standard in Pediatric Dentistry

We are leading the way nationally on:

• Advanced pediatric intraoral scanning
• CAD/CAM pediatric design
• Biocompatible 3D printing for kids and teens
• Custom, metal-free space maintainers

“SmileKeeper ^TM”  is part of that evolution.

If your child recently lost a baby tooth early…

Or you’ve been told a space maintainer is needed…

“SmileKeeper ^TM” may be the perfect fit.

We will gently evaluate your child, scan comfortably and quickly, and create a kids space maintainer made just for them because their smile deserves the best.

Call us at Smiles Pediatric Dentistry & Orthodontics Or schedule a consultation on our website

 Contact us here.

FAQ:

1. What is a space maintainer for kids and why might my child need one?

A space maintainer is an oral appliance that is used to hold the space of a primary molar (baby molar) that needed to be removed prematurely due to unrestorability. This can happen when a primary molar has a large carious lesion (cavity) that has damaged the tooth beyond repair and the permanent tooth that is developing to replace it is far from coming in the mouth.

2. What happens if a baby tooth is lost too early without space maintenance?

Without holding the space in the dental arch for a prematurely lost primary molar, the adjacent teeth will tip into that space blocking the future permanent tooth from coming in properly.

3. How does a 3D printed space maintainer work?

Like a traditional metal band and loop space maintainer, a 3D printed space maintainer holds the space for the future permanent tooth that is developing. It is bonded onto the adjacent molar (primary or permanent) and extends into the space of the missing baby tooth.

4. How is SmileKeeper different from conventional metal band-and-loop space maintainers?

It is fully customized in terms of design ad fit. It is easily adjustable inside of the mouth and is esthetically pleasing because it is tooth colored. It can also be updated as needed by adding composite resin while in place.

5. How do digital oral scans for children make the process easier?

A digital oral scan is so much easier for kids of all ages than a traditional impression. The comparison of the two is like night and day.

6. Is a 3D printed space maintainer comfortable for my child?

Yes! It should blend seamlessly in the mouth because it is custom made and fit to perfection with digital percision.

7. Q: How can families reach your pediatric dentist office in West Los Angeles to schedule a consultation for SmileKeeper?

Families can reach our dental team at Smiles Pediatric Dentistry & Orthodontics in West Los Angeles by calling our office, sending us a message, or requesting an appointment through our website. During a consultation for SmileKeeper, we gently evaluate your child’s early tooth loss, take comfortable digital scans, and determine whether SmileKeeper, our 3D-printed space maintainer, is the right option for protecting the space for the developing permanent teeth. Our goal is to make the process easy, gentle, and reassuring for both children and parents.

In 2008, I set out to remodel a small, free-standing building built in 1946 in West Los Angeles that I was fortunate to lease. I’d come across the ad on the CDA website while I was working overseas and planning my return to California. I followed the lead. The building was an existing dental office that had been leased several times over the years. The bathroom was the size of an airplane lavatory, the windows were tiny, but the space had a beautiful legacy. When I walked through it, I could already see the vision of what was to come.

The project was both expansive and expensive. Fate would have it that a loan was secured just before the financial crash that came that same year. I handled much of the contracting, permitting, and design personally, heading to the Los Angeles Department of Building and Safety endless times, big plan rolls in hand. Then, I did what Pico Boulevard hadn’t seen before: I painted the entire building a bright yellow that sang to my heart and caught the eye of an artist-photographer a few years later, who featured it in his exhibition. More importantly, it became a beloved neighborhood landmark.

From Paper to Digital: The Early Steps in a New Kind of Pediatric Dentistry

Design decisions come with every project, but when it comes to creating a dental office, those decisions happen on both macro and micro levels. The Structure on one end, and minute clinical details on the other. Designing a dental space is like designing an elaborate home kitchen. You need to plan where the outlets go, what devices will live there, and how people will move through the space.

Digital dentistry has always been on my mind. In 2008, it presented through the challenge of space. The office size was small, and I had big plans. I knew from the start that I couldn’t afford a dedicated room for files. That turned out to be a gift. I was never a fan of paper charts; they seemed inefficient and unhygienic. When I was an associate, I’d see shelves and shelves of them handled by busy staff, in gloved and ungloved hands alike. It didn’t feel right.

So, I searched for a collaborator who shared the same vision of a digital pediatric dentistry future. I found Alex Furer, founder of a company called MedicTalk. He offered exactly what I was looking for: Digital charts and consent forms. The first time I called, we spoke for nearly two hours. I didn’t need convincing. I was ready for immediate adoption. With that decision, I replaced what would have been a paper chart room with a back office, giving new life to my 1,300-square-foot space and making a life-long friend in Alex.

The Spark That Changed Everything: From Analog To Digital Dental Imaging

Next came imaging. Traditional dental films were still common, but some practices were transitioning to phosphor plate systems. These are thin, flexible films that require scanning. I almost invested in a system until an IT tech, named Frank Schettini, asked me a question that changed everything:

“If you could know the outcome of an image instantly, without keeping your little patient waiting, would you like that?”

My answer was an instant yes. These sensors were designed for adults, but I believed that children deserved the same level of innovation and comfort. With practice, diligence and some tweaking, we figured out how to use them for kids smoothly. I made the same decision for large scale, extra oral imaging, setting up the office with a complete imaging suite.

That shift toward digital imaging reshaped how I practiced pediatric dentistry and added unparalleled dimension to our orthodontic treatment planning. It also set the stage for adopting full digital workflows, replacing all analog oral impressions (you know, the goopy stuff) and messy lab supplies with sleek intraoral scanners, capable of taking digital impressions in minutes and an in-house digital pediatric and orthodontic dental lab. Our environment became faster, cleaner, more comfortable, and more connected to the child’s and parent’s experience.

The Smiles Name

The name of our practice is not elusive. In fact, “Smiles” is a word commonly used in dentistry, but choosing it for me came from a deep desire to see children happy. The beauty of working with kids is enjoying their authenticity. A child’s smile is probably the most honest and true form of elevated emotion humanity can experience. It is also a language that is never misunderstood. It rings clear and warms the soul. That is why I chose this word to represent our service.

A Vision Beyond Themes

Many pediatric dental offices follow familiar motifs like jungles, oceans, or outer space. They’re playful and inviting, but I had a different vision for Smiles. I imagined every infant and toddler who walked through our doors eventually returning as a teenager and young adult. I wanted an environment that would grow with them. One that felt timeless, clean, and welcoming to all.

I also wanted a clean silhouette that would invite parents into a space that felt clear, clean and organized, yet bright and cheerful. During dental visits, parents often ask, “Is this a franchise?” or exclaim, “This place feels like Disneyland!” Those moments affirm what I hoped to create: A dental home that feels magical, safe and comfortable. Built from warmth, honoring precision, and radiating joy.

Designing Shape, Form, Function

I’ve always been a designer at heart. Shaping, refining, and harmonizing form and order. I design in 3D, in art, and in the smiles that I help create. When Smiles was built, I had no budget for an interior designer, so I hired myself for that job. To decorate the walls, I set up a makeshift bench as the construction workers worked, bought a bunch of canvases and acrylic paints from Michaels (on sale), and got to work. It amazes me how many compliments I’ve gotten on these spontaneous art pieces over the years. So, I started to add more of them and gave time to pursuing my artistic adventures, something that has brought me so much fulfillment.

These original paintings still grace our walls. Over the years, kids and parents have often commented on the warmth and joy they bring to our space. They’ve become part of our dental office design story and a reminder that creativity and authenticity can elevate a pediatric dental practice as much as technology can.

Our building is a free-standing space that allows us to open the doors and windows to the light of the sun. Our building is ADA accessible and easy to navigate. During the pandemic, despite the strict guidelines that dental offices needed to follow, I realized that we were already living many of those practices. The day-to-day protocols like allowing fresh air to circulate, to maintaining in-house laundry, to cleaning and wiping of surfaces were already integrated in our everyday practices. Our philosophy of care has always included the health of our space as an expression of love and respect for those we serve.

Color!

Almost every day, I get asked this: “Why did you choose the color yellow?”

The answer is simple: Because I wanted to bring brightness to a field that has long been associated with challenge. Yellow is fun, uplifting, and cheery. It’s a color that radiates optimism and is universally well-received. It reflects the warmth we feel for our families and the joy that flows through our work.

Every item at Smiles is custom made or carefully sourced. Let me tell you, furniture doesn’t typically come in yellow and orange! But I take great pride in finding these items and customizing them or collaborating with artisans who can create them.

People also ask me if everything I own is yellow! I’m often seen walking in the neighborhood in yellow (or orange) scrubs. I laugh because I do gravitate toward bright colors and love to wear yellow! That said, a better description of me would be a rainbow because I also love the rest of the color wheel too.

The Blue Logo and Orange Trim

Our logo is blue. It’s the color of clarity. It stands out beautifully against our yellow building and brings balance to its warmth. I didn’t realize it at the time, but many leading brands have chosen blue for the same reason. Blue communicates trust, calm, and connection. From companies like Oral-B, LinkedIn, and American Express to Samsung and IBM, blue has long represented reliability and intelligence.

As for the orange, there’s a story there. While I was building the office, I made wonderful friendships with my neighbors on both sides. On one side was The Children’s Book World, the most beautiful bookstore, a place of pure awe and adventure, lovingly led by Sharon Hearn for decades. On the other was Dr. Kevin Komatsu, a wonderful general dentist whom I entrust with my own dental care.

One afternoon, during a conversation with friends at the bookstore, someone smiled and said, “You’re a USC Trojan. You’ve got to have orange!” Another light bulb went off. Yes, I do.

Orange became the perfect finishing touch. A color of warmth, creativity, and vitality. It bridges the cheer of yellow with the confidence of blue, embodying both connection and joy. Together, these colors reflect who we are. Bright, clear, and joyfully inspired by community.

LINK to the Children’s book world:
https://childrensbookworld.com

Budget, Planning and Beliefs

There is no doubt that budgets are part of every project, and that cost is something on every practice owner’s mind. Over the years of running a pediatric dentistry business, I’ve come to appreciate that both structure and intuition play vital roles in every decision.

I’ve always had the aspiration of enrolling in an MBA program. Something in me longs for the pragmatism of structured spreadsheets and analytical outcomes. Maybe this will be a chapter yet to come. However, I’ve understood that the way I function is on a more energetic level. I certainly love to organize and plan, but the way I handle financials is guided by belief. Here are some of the ways that I flow through life:

• When we do good, good follows.
• When the heart calls, the call must be answered.
• Some investments just have to be made.
• Honor everything, waste nothing.
• Recycling, upcycling, and recreation are endlessly enriching and fulfilling.
• Appreciation is the breath of life.

Evolving Spaces, Evolving Care

I’ve remodeled Smiles four more times over the last seventeen years. Each time, we’ve refined, added, and adopted better, smoother systems and more advanced technologies. Parents rarely see these transitions. Our “reimagining’s” happen in the evenings, on weekends, and during planned closures. But every change becomes part of the warm, sunlit story that is our yellow building and embodies the beliefs that I live by.

When it’s time to update an item or replace a technology system, the existing one gets donated to a community clinic or someone who can joyfully repurpose it. Larger units like our 3D Conebeam unit (we are on our third to reduce radiation and image gently), get traded in and upgraded. Well cared for instruments get donated to dental students that need them to practice and perfect their skills.

I also take a moment to bless every item and thank it for the service it provided documenting with sentimental photos that my children can’t yet figure out but I know will one day will understand.

From Vision to Virtual Design
Today, my latest remodeling projects live inside a computer. I’m beta testing AI integrations in digital dental imaging and creating digital pediatric and early orthodontic workflows using CAD/CAM technologies. Over the past three years, I’ve focused on adapting adult digital dentistry tools to benefit children and teens, making 3D printing in pediatric dentistry and orthodontics not only possible, but beautiful and practical.

Children deserve precision, comfort, and innovation as much as adults do, and at Smiles, they now receive it. Digital pediatric dentistry and early orthodontics is happening daily in the yellow building.

Always Becoming

The path of our office, and of pediatric dentistry itself, is ever evolving. Being part of that evolution is my calling. One of deep passion for creating comfort, sponsoring health, and stewarding joy. These aspirations may sound idealistic for a field like dentistry, but similar to every remodel I’ve undertaken, they begin with a small spark and a dream to make care gentler and brighter for every child.

Like I tell the kids that come to see me: “Your teeth need to last for the next one hundred years so, you gotta love them!”

Schedule your child’s first dental visit today! Contact us here.

I am personally invested in sports dentistry, not only as a pediatric dentist but also as a mother. My ten-year-old son Zane is in love with soccer. He thinks about it, analyzes it, plays it, and envisions it as his future pursuit. His passion and organic commitment warm my heart, and I truly enjoy watching the friendships and camaraderie he builds with his teammates. As his mother, my goal (pun intended!) is to nurture Zane’s long-term dreams by teaching him the intricacies of the mind–body connection. A healthy athlete is safe when their mind feels good and their body is performing at its best. Achieving and maintaining this balance requires a collaborative team that grows with the athlete as they advance to new levels of development.

The mind is everything:

The field of epigenetics has demonstrated the profound power the mind holds over the body. In the words of the late Louise Hay, one of my greatest guides: “Our thoughts shape our lives.” Dr. Joe Dispenza’s research echoes this truth. For young athletes, laying a strong foundation begins with teaching them focus. True competition is not about external comparisons; it is about becoming better than yesterday’s self. When young athletes understand this, they can relax, enjoy the game, challenge themselves, and celebrate their teammates’ achievements as much as their own, simply because those successes pose no risk to their personal progression.

Honoring the body:

Listening to one’s body means learning its subtle language. For athletes in it for the long run, this includes fueling with nutrient-rich foods, hydrating consistently, and stretching muscles before and after play. A hungry athlete might pause to ask, “What will truly nourish me in this moment?” rather than grabbing the first snack in sight. Hydration, likewise, is best practiced before thirst even strikes. Finally, knowing when to stop is just as important a skill as knowing when to go. Athletes who push themselves beyond their body’s comfort level may shine in the short term but often face the consequences later on.

Wellness infrastructure:

Protecting an athlete’s dental health is part of protecting their holistic well-being. Biannual dental and oral examinations in sports are just as essential as periodic physicals and vision checks. They help detect early signs of tooth decay and periodontal issues that can cause discomfort and affect an athlete’s performance. Orthodontic evaluations can reveal misalignments or protruding front teeth that are in a “trauma zone” and should be addressed early to reduce risk of injuries or fractures.

Prevention of dental trauma and orofacial injuries:

Athletes of all ages need to be protected from both bodily and orofacial injuries. While sports and athletics are an integral part of our children’s lives, dental trauma should not be part of the game. With12–33% of children experiencing traumatic dental injuries (TDIs) by age 12, it is crucial to take precautionary and safety measures to ensure that our children stay healthy. Contact sports like basketball, football, and hockey have the highest rates (up to 50%) of sports-related dental injuries, while soccer, baseball, and lacrosse also pose substantial risks. Prevention, especially through custom mouthguards, is key.

Why Sports Dentistry Matters

• A healthy athlete has a better chance at peak performance levels than one that is in mental or physical discomfort.
• Dental injuries are the most common orofacial injuries in sports.
• Dental trauma impacts more than teeth. It affects nutrition, systemic health, psychosocial well-being, self esteem and finances.
• Long term follow-up is essential for dental injuries.
• Athletes not wearing mouthguards are up to 60 times more likely to sustain dental injuries.
• Parents and caregivers are instrumental in empowering their children to adopt preventative measures such as protective gear and mouthguards.
• Timely intervention can preserve teeth, prevent long-term damage, and minimize complications.

Prevalence of Dental Trauma in Sports: The Global Landscape

Sport	Estimated % of Sports-Related Dental Injuries	Notes/Context
Basketball	40–50%	Highest in U.S.; often non-mandatory mouthguards
Football	Up to 50% (historically)	Rates dropped with helmet/mouthguard mandates
Hockey	Up to 50% (historically)	Mandates have reduced rates, but still significant
Martial Arts/Boxing	>50% (without protection)	High risk due to direct facial contact
Soccer	7–25%	Varies by age, region, and level of play
Baseball/Lacrosse	10–20%	Ball/stick impact; often overlooked
Rugby	20–30%	High contact, variable mouthguard compliance
Gymnastics, Skateboarding, Biking	5–15%	Falls, collisions, less frequent mouthguard use

Custom fitted Mouthguards: The Gold Standard of Care

The American Dental Association (ADA), The Academy for Sport Dentistry (ASD), The Academy of Pediatric Dentistry (AAPD) and the International  Association of Dental Traumatology (IADT) recommend mouthguards for over 29 sports

Types of Mouthguards:

• 1. Stock: Least protective, limited fit, low compliance.
  2. Boil-and-Bite: Better fit, but can deform and be bulky.
  3. Custom-Fit: Best fit, comfort, and protection. Can be vacuum formed or 3D printed.

Athlete participation in mouthguard wear:

• For an athlete to wear a mouthguard, they must be comfortable while wearing it, be able to speak and breathe easily with the guard in their mouth and the guard must be stable to avoid dislodgement.
• Custom mouthguards lead to higher compliance and better outcomes because they fit better.
• Custom appliances can be fitted over fixed orthodontic brackets to make the continuation of care seamless.

 

How can we encourage our young athletes to wear Mouthguards:

• Advocacy: Encourage leagues, schools, and coaches to mandate mouthguard use in all at-risk sports. The rule of “No Mouthguard, no play” needs to be part of the game.
• Education: Parents, athletes, and coaches must understand the risks and benefits of proper safety precautions and mouthguards.

Emergency Management: The On-Field Playbook

• Fractures: Find/Keep fractured crown fragment(s) and place it in water. These can be bonded to the tooth structure.
• Luxation Injuries: Concussion, subluxation, intrusion, extrusion, lateral luxation. In these instances, head to your dentist to reposition or stabilize the dislodged teeth.
• Avulsion: Complete displacement of tooth from socket. Immediate replantation (within 5-15 minutes is ideal). Hold tooth by the crown, not the root and return it to its socket or place it in a “save-a-tooth” kit or milk or saliva, never water. Seek immediate dental care.

• Follow IADT Guidelines: iadt-dentaltrauma.org

The Team Dentist:

• Team Dentists Collaborate with Coaches and Athletic Trainers to Support Athlete Wellness.
• The Acadmey for Sports Dentistry (ASD) lists the following benefits of the team dentist as follows:

-Immediate response to sports-related dental emergencies and trauma

-Strategic prevention planning developed alongside coaching and training staff

-Performance optimization by identifying oral health factors that impact athletic ability

-Holistic wellness support through comprehensive, integrated healthcare approaches.

Here is the outline of my strategy to support sports dentistry in my community:

1. Education and Awareness: For both the parents and the coaches through presentations explaining the importance of dental protection in sports, highlighting the prevention of injuries, and emphasizing the important role of mouthguards.
2. Showcasing samples: Offering samples of mouthguards available for kids to see, feel and touch.
3. Customization event: Hosting a “mouthguard fitting day” event for a local team where digital scans can be obtained. Personalize the mouthguards with team colors or player names to increase appeal.
4. Collaboration with coaches and team management: Promoting and encouraging mouthguard usage.
5. Regular monitoring: Establish a system where coaches check for mouthguard gear.
6. Incentive program: Reward players who consistently wear their mouthguards during practice and games with prizes and recognition “mouthguard champion of the month”
7. Involving parents: Hosting a seminar to highlight the long-term benefits of wearing a mouthguard and explain the financial benefits of preventing dental injuries with mouthguards compared to the cost of injury treatment.
8. Providing mouthguard checks at the dental office: Every season, free mouthguard checks during routine dental visits.
9. Highlighting success stories of teams and player and sponsor a team to spread awareness.
10. Enjoying a fun and safe game!

The Future of Sports Dentistry: Innovations and Trends

• Advanced Materials and Digital Fabrication
• Multi-laminate mouthguards with enhanced shock absorption.
• 3D printing and CAD/CAM technology to allow more rapid, precise, and cost-effective custom mouthguard fabrication, even for orthodontic patients.
• Tele-dentistry and AI
• Immediate triage: Smartphone-based consultations for on-field injuries
• AI diagnostics: Future platforms (like DentalGPT’s ODIN Clinical Vision AI) will analyze photos and radiographs for rapid trauma assessment.
• Concussion Mitigation Research
• Evidence suggests custom mouthguards may reduce concussion risk by dissipating impact forces.
• Personalized, Digital, and Connected Care
• Integration with electronic health records and digital communication platforms will improve care coordination and emergency response.

Key Takeaways

1. Dental trauma in sports is common and preventable.
2. Custom-fit mouthguards are the gold standard for prevention.
3. Proper emergency management is critical for prognosis.

4. The future is digital, personalized, and collaborative.

Action Steps

• Parents & Athletes: Insist on mouthguard use for all at-risk sports.
• Coaches & Schools: Enforce “No Mouthguard, No Play” policies.
• Dental Professionals: Educate, advocate, and provide custom appliances.

Every time a child runs onto the field, their smile goes with them. Sports dentistry ensures that smile stays safe, strong, and ready for every victory. With the right protection and the right guidance, our young athletes can focus on what matters most: Playing the game they love, while parents rest easy knowing their smiles are cared for.

Schedule your child’s first dental visit today! Contact us here.

As a pediatric dentist, I truly believe that the most important roll I play is to promote oral health and wellness for life. To me, that means honoring the magnificence of the human body and its amazing capacity to regenerate and heal. After spending years perfecting my skills in traditional dentistry, I never stopped searching for alternative pathways to promote oral health. When I was introduced to laser technology, I knew it would be game changer. Laser has offered me an instrument that is not only healing but is also artistic in its power. The technology has truly transformed the way I practice and serve the children that visit our office.

At Smiles Pediatric Dentistry & Orthodontics, we are proud to be part of the dental laser evolution. Our laser therapies bring healing, comfort, precision, and compassion to modern pediatric and teen dental care, often without the need for injections, numbness or drills.

Let’s explore this fascination technology and how it is shifting the way we are providing dental care.

The Power’s in the Light:

Dental procedures are a lot for an adult to handle let alone a child, yet they are commonly underrated in complexity. In their truest nature, they are microsurgical procedures which have been traditionally performed with mechanial instruments.Laser innovations have transformed dental experiences from being tactile and jarring to smooth and flowing. The sensations that are experienced throughout the care are more comfortable and the treatment is minimally invasive when compared with traditional methods.

Laser does not “cut” tooth structure. It ablates it when the tooth absorbs the laser’s power. What is even more facinting is that lasers can also have a healing effect that promotes wellness.

Laser Throwback:

The concept of lasers began in theoretical physics. In 1917, Albert Einstein introduced the principle of stimulated emission, setting the stage for laser development. By 1960, Theodore Maiman built the first working laser using ruby crystal. This early technology was soon applied in medicine, with pediatric dentistry and laser dentistry exploring its potential by the late 1960s.

Albert Einstein by Oren Jack Turner (1947)

commons.wikimedia.org

The Early Days: Experimental Use in Dentistry

During the 1960s and 70s, researchers experimented with ruby and CO₂ lasers on teeth and gums. While promising, these first attempts were limited by thermal damage and lack of precision.

Stepping into the Clinic: FDA Approval and Soft Tissue Care

The first real clinical milestone came in 1989 when the FDA cleared the Nd:YAG laser for soft tissue dental use. In the 1990s, soft tissue lasers like CO₂ and diode lasers became popular for procedures like gingivectomy, frenectomy, and periodontal therapy, offering bloodless surgery and faster healing.

The Era of Hard Tissue Lasers

In 1997, a breakthrough came with the FDA’s clearance of the Er:YAG laser for hard tissue applications in enamel, dentin, and bone. The following year, the Er,Cr:YSGG laser debuted, combining versatility with precision. Dentists could now prep cavities and treat bone more gently than ever before.

Modern Laser Dentistry: Solea® and Beyond

In 2013, the Solea® laser was introduced. Solea offers CO₂ laser technology optimized for both soft and hard tissues. Its 9.3 µm wavelength made it possible to prep teeth without needles or drills. It is currently the latest laser option on the market that has the widest range of treatment options. In the 2020s, lasers became integral in cosmetic contouring, periodontal regeneration, and digital workflows with CAD/CAM and 3D printing.

Timeline Summary: Major Milestones in Laser Dentistry

How Can Lasers Have a Healing Effect In Dentistry?

The healing effects of lasers are not simply anecdotal. They are grounded in robust cellular biology, clinical research, and decades of technological refinement. Understanding how lasers facilitate healing requires a look at both the underlying science and their practical applications.

Biological Effects of Dental Lasers

1. Enhanced Cellular Energy and Repair

• ATP Boost: More ATP means cells can repair themselves faster and more efficiently.
• Fibroblast Proliferation: Fibroblasts, the cells responsible for producing collagen and extracellular matrix, are stimulated, leading to faster wound closure and tissue regeneration.
• Osteoblast and Osteoclast Activity: In bone, lasers can stimulate osteoblasts (bone-forming cells) and modulate osteoclasts (bone-resorbing cells), supporting bone remodeling and regeneration, crucial in orthodontics.

1. Modulation of Inflammation

• Cytokine Regulation: PBM reduces the production of pro-inflammatory cytokines (such as IL-1, IL-6, TNF-alpha) and increases anti-inflammatory mediators.
• Reduced Swelling and Redness: This leads to less postoperative swelling, erythema, and discomfort.
• Faster Resolution of Inflammatory Lesions: Conditions like aphthous ulcers and herpetic lesions heal more quickly with laser therapy.

1. Analgesic (Pain-Relieving) Effects

• Endorphin Release: Laser therapy can stimulate the release of endorphins, the body’s natural painkillers.
• Nerve Conduction Modulation: Lasers can temporarily block the transmission of pain signals along nerve fibers.
• Reduced Pressure on Nerves: By decreasing inflammation and edema, lasers relieve pressure on nerve endings, further reducing pain.

1. Improved Vascularization and Circulation

• Angiogenesis: Lasers promote the formation of new capillaries in healing tissue, improving blood supply and nutrient delivery.
• Vasodilation: Enhanced blood flow accelerates the removal of waste products and supports tissue repair.

1. Antimicrobial and Sterilizing Effects

• Bacterial Reduction: Certain laser wavelengths have bactericidal effects, reducing the microbial load in surgical sites and root canals.
• Sterilization of Wounds: This lowers the risk of postoperative infection and supports cleaner healing.

What is Photobiomodulation (PBM)?

Photobiomodulation (PBM), formerly known as low-level laser therapy (LLLT), is a non-thermal therapeutic technique that uses specific wavelengths of light (usually in the red to near-infrared spectrum, 630–1000 nm) to modulate cellular function. Unlike high-powered surgical lasers, PBM does not cut or ablate tissue. Instead, it delivers low-level energy that is absorbed by cellular chromophores, primarily cytochrome c oxidase in mitochondria, initiating a cascade of biological effects.

Clinical Effects in Dentistry:

• Pain Reduction: After orthodontic adjustments, extractions, or surgical procedures.
• Wound Healing: Faster recovery of soft tissue lesions, aphthous ulcers, and post-surgical sites.
• Reduction of Dentin Hypersensitivity: By modulating nerve response and promoting reparative dentin.
• Potential Acceleration of Orthodontic Tooth Movement: By stimulating bone remodeling (osteoblast and osteoclast activity), though evidence is variable.

The Gemini Laser Unit: Photobiomodulation In Action:

The Gemini 810 + 980 Diode Laser is a state-of-the-art, dual-wavelength soft tissue laser designed for both surgical and non-surgical dental applications. It is the first dual-wavelength diode laser available in the U.S., combining the benefits of two key wavelengths:

• 810 nm: Optimal absorption by melanin and hemoglobin, making it effective for cutting, coagulation, and hemostasis in pigmented soft tissues.
• 980 nm: Greater absorption by water, enhancing ablation and vaporization efficiency, and providing a different tissue interaction profile.

Key Features:

• Dual-Wavelength Operation: Use 810 nm, 980 nm, or both simultaneously for tailored clinical effects.
• Super-Pulsed Mode: Delivers high peak power in ultra-short pulses, minimizing collateral thermal damage and improving patient comfort.
• Versatility: Suitable for a wide range of soft tissue procedures and photobiomodulation applications.

The Healing Effects of The Solea CO₂ Laser Revolution:

The Solea CO2 dental laser, when used with its “protect” handpiece, can thermally modify the enamel surfaces effectively “fusing” and “hardening” it. This makes enamel more resistant to acid attack and caries. The effect is achieved through controlled, sub-ablative laser energy that alters the crystal structure of enamel without removing tooth structure, and is clinically used for caries prevention, sealant preparation and reducing white spot lesions.

Scientific Basis: How CO₂ Lasers Modify Enamel

Wavelength and Enamel Absorption

• The Solea CO₂ laser operates at 9.3 µm, a wavelength highly absorbed by hydroxyapatite, the primary mineral in enamel.

• This absorption is far greater than with other dental lasers (e.g., Er:YAG, diode), making CO₂ lasers uniquely suited for precise, controlled interaction with hard tissues.

Thermal Modification, Not Ablation

• When delivered at sub-ablative (non-cutting) energy settings, the laser gently heats the enamel surface.

• This controlled heating does not vaporize or remove enamel, but instead induces a micro-melting and rapid re-solidification (recrystallization) of the outermost enamel layer.

Chemical and Structural Changes

• The process drives out carbonate ions from the hydroxyapatite lattice.

• Carbonate-rich hydroxyapatite is more acid-soluble; removing carbonate creates a purer, denser, and less acid-soluble crystal structure.

• The result: increased microhardness and significantly improved resistance to acid demineralization, the fundamental process behind caries.

“Fusing and Hardening” Explained

• “Fusing” refers to the partial melting and re-solidification of enamel crystals at the micro-scale.

• “Hardening” reflects the measurable increase in surface microhardness and acid resistance.

• These effects are well-documented in the scientific literature and are the basis for laser-based caries prevention protocols.

Clinical Applications and Benefits

A. Caries Prevention

• Laser conditioning of enamel is especially valuable for high-risk patients, newly erupted molars, and pediatric populations.

• Studies show a significant reduction in caries incidence on laser-treated surfaces compared to untreated controls.

B. Sealant Preparation

• Pre-treating pits and fissures with the Solea laser before sealant placement:

  • Cleans and sterilizes the surface.

  • Increases sealant retention by creating a micro-roughened, acid-resistant surface.

  • Reduces microleakage and sealant failure rates.

C. White Spot Lesion Prevention (Orthodontics)

• Laser treatment around orthodontic brackets can dramatically reduce the risk of white spot lesions, a common complication during fixed appliance therapy.

D. Hypersensitivity Management

• By sealing exposed dentinal tubules, sub-ablative laser treatment can reduce sensitivity, especially in cervical areas.

E. Adjunct to Other Preventive Measures

• Laser conditioning can be combined with fluoride application for synergistic effects, further enhancing enamel resistance.

Effects of Solea CO2 Laser on Oral Biofilm:

Oral biofilm (dental plaque) is a structured community of microorganisms embedded in a self-produced extracellular polymeric substance (EPS), adhering to teeth and soft tissues. Biofilm is the root cause of caries and periodontal disease, and its removal is a cornerstone of preventive and therapeutic dentistry. Bonded restorations require a clean surface to adhere to. Traditional mechanical debridement has its limitations, especially in young children.

Mechanisms of Solea’s Action on Oral Biofilm

1. Rapid Water Absorption and Ablation

• Biofilm Composition: Up to 80% water, with bacteria, EPS, and host proteins.
• Laser-Biofilm Interaction: The Solea laser’s energy is absorbed by water molecules in the biofilm, causing instantaneous vaporization (ablation).
• Result: The biofilm is physically disrupted and removed from the surface, including from micro-irregularities and hard-to-reach areas.

1. Bactericidal and Antimicrobial Effects

• Thermal Lethality: The rapid temperature rise denatures bacterial proteins, disrupts cell walls, and causes cell death.
• Spectrum of Action: Effective against a broad range of oral pathogens, including:

• • Streptococcus mutans (caries)
  • Porphyromonas gingivalis (periodontal disease)
  • Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and others

• EPS Disruption: The laser breaks down the EPS matrix, which is the “slime layer” that protects bacteria from host defenses and antimicrobials.

1. Prevention of Recolonization

• Surface Modification: Laser treatment can alter the surface energy and microtopography of enamel and dentin, making them less hospitable to new biofilm formation.
• Reduced Bacterial Adhesion: By disrupting the EPS and removing the initial colonizers, the laser impairs the ability of bacteria to reattach and form new biofilm.

4. Clinical Applications and Advantages
5. A. Caries and Restorative Dentistry

• Caries Removal: The laser can ablate carious tissue and associated biofilm, preparing a clean surface for adhesive restorations.
• Minimally Invasive: Reduces the need for rotary instruments, preserving healthy tooth structure and improving patient comfort.

1. Dental Hygiene and Prophylaxis

• Adjunct to Routine Cleaning: The Solea laser can be used to remove biofilm from fissures, interproximal areas, and subgingival sites that are difficult to access with traditional instruments.
• Patient Comfort: No sharp instruments, less noise, and reduced vibration make the experience more pleasant, especially for

1. Gingival Care and Health Maintenance

• Debridement: Solea can be used to debride and remove biofilm and inflamed tissue with minimal bleeding and discomfort.

How We Use Laser at Our Practice

At Smiles Pediatric Dentistry & Orthodontics, We use several laser units based on each child’s specific needs. Harnessing both CO2 and Diode (Gemini) laser theapy, we are able to offer soft and hard tissue laser theapy solutions in addition to the healing effects of photobiomodulation.

Here’s how we use Solea:

• Anesthesia-free cavity preparation for restorations
• Gentle procedures for children with sensory sensitivities or dental anxiety
• Efficient visits that reduce fear and increase cooperation
• Soft tissue procedures such as tongue-tie and lip-tie releases (frenulotomies/frenulectomies) with minimal trauma
• Surgical procedures for soft tissue like gingivectomy and gingivoplasty, biopsies
• Surgical procedure for hard tissues and impacted teeth
• Orthodontic tooth exposures involving soft tissue and bone

Here’s how we use Gemini:

• Soft tissue procedures: Gingivectomy and gingivoplasty, frenectomy (labial and lingual), hemostasis and coagulation, biopsy of soft tissue lesions
• Pain management for ulcers, cold sores and minor abrasions
• Photobiomodultion to promote healing post dental procedures and TMJ therapy

Where Science Meets Gentle Care

Laser dentistry is more than a leap in technology. It is a new philosophy of care, one that values comfort as much as clinical excellence. In my hands, the power of laser light has transformed the way I approach pediatric and teen dental care, and it continues to amaze me every day.

If you’re curious whether laser treatments are right for your child, we’re here to answer every question, and make every visit feel safe, modern, and full of smiles.

Schedule your child’s first dental visit today! Contact us here.

When a 2-year-old girl lost her front tooth after an abscess due to a traumatic fall a few days before her second birthday, her parents were heartbroken. Not only did this little one deal with fever, swelling and discomfort, she now was missing part of her smile.

Traditional dental replacements for toddlers are often bulky, uncomfortable, and not well designed for such young children. But thanks to advancements in digital dentistry and in-office 3D dental printing, we were able to offer something different.

A gentle, beautiful, and custom-fit solution that honored both the child’s development and the family’s wishes.

The Challenge of Replacing a Baby Front Tooth

Dental injuries in toddlers are more common than most people realize, and when a front tooth needs to be removed, whether due to trauma or infection, parents often feel helpless. They want to preserve their child’s smile, but most replacement options are invasive, require metal bands and even sedation to deliver. This can certainly feel overwhelming for the parents and the child.

In this case, the patient was not even two years old when she experienced a crown fracture to her upper right front tooth (baby tooth E). Initially stable, the tooth later became infected and had to be removed. Her parents were understandably concerned, not just about function, but about how this would affect her appearance, social interactions, and emotional well-being.

A Gentle, Growth-Friendly Alternative

After an in-depth conversation with the family which included a review of all treatment options, we landed on something truly innovative: a digitally designed, 3D printed pediatric cantilever bridge that would replace the missing primary tooth without drilling, metal, or local anesthesia.

Using a digital intraoral scan and computer-aided design (CAD), we created a tiny crown to gently fit over the neighboring baby lateral incisor (tooth D). From this crown, a small pontic (replacement tooth) would cantilever into the space where tooth E had been. The entire appliance was printed in our office using a safe, biocompatible resin and delivered in a single, short visit, without needing any sedation.

What Made This So Unique?

• No prep, no anesthesia, no metal: The supporting tooth was left completely intact. And no bands, and no discomfort were present.
• Behaviorally appropriate: The child was comfortably placed in a knee-to-knee position on her parent’s lap for both the oral scan and the subsequent delivery visit. Both visits were efficiently completed within 15 minutes of time.
• Esthetic and light: The restoration blended beautifully with her natural teeth and was lightweight and comfortable.
• Digitally streamlined: From scan to design to print, the whole procedure was completed in-house, allowing for rapid, precise delivery.

A Look Inside the Process

Here’s how we created this tiny-yet-mighty smile solution:

1. Intraoral Scan: Captured a digital image of the healing socket and surrounding teeth using the iTero Lumina scanner.
2. Design: Used CAD software (Exocad) to create a no-prep, full-coverage crown for tooth D that would support the cantilevered pontic to replace tooth E
3. Print: Fabricated the appliance in-office using SprintRay’s biocompatible ceramic crown resin.
4. Delivery: Seated and bonded the appliance using heated flowable composite after verifying fit and function on a model, sandblasting and then fitting in the mouth, all while the child remained calmly in her parent’s arms.

The Results? A Happy, Confident Smile

At both the one-week and two-month follow-ups, the restoration remained well situated. The surrounding gum tissue looked healthy, and most importantly, the child was smiling confidently again.

Her parents told us they saw a real difference in her social interactions, mood, and willingness to show off her new tooth.

We continue to monitor the case for any needed adjustments but are very excited about the possibilities that 3D printed options present in pediatric dentistry. We believe that these 3D printed solutions will only get better and better.

Why This Matters

For pediatric dentists and parents alike, this case opens up a world of possibilities. We now have the tools and technology to offer young children gentle, fully-customized, esthetic, and growth-friendly alternatives to traditional pediatric partials.

By embracing digital workflows and in-office 3D printing, we can:

• Reduce the need for sedation
• Preserve natural tooth structure
• Deliver highly personalized solutions in a single visit
• Support emotional healing after trauma

Final Thoughts

This case represents a quiet revolution in pediatric dentistry. As digital tools become more accessible, they allow us to care for even our littlest patients in ways that are less invasive, more esthetic, and more emotionally supportive. For this tiny patient and her family, a little 3D magic made all the difference.

If you’re a parent navigating early childhood tooth loss, or a provider looking to offer advanced, child-centered care, the future is already here, and it’s being 3D printed.

Welcoming a new life into this world and experiencing the unconditional love that it brings with it is a transformational experience. A deep desire to nurture and protect this new presence naturally follows as new parents collaborate to provide their newly born with warmth, safety, and nutrition.

Many new mothers who choose to breastfeed are surprised to find out that the process, as intimate and rewarding as it is, has a bit of a learning curve. The early days of breastfeeding bring both joy and unexpected challenges. Painful feeds, difficulty latching, or concerns about milk transfer often lead parents to wonder whether a tongue-tie or lip-tie could be the cause.

In recent years, the number of infants undergoing tongue-tie (lingual frenulotomy) and lip-tie (labial frenulotomy) procedures has grown significantly. At the same time, leading pediatric and dental organizations are actively studying these trends to better understand when intervention is appropriate and when more conservative approaches may be equally effective.

As a pediatric dentist and a mother, I approach this topic with both clinical precision and deep compassion for parents navigating these concerns. My goal is to help parents feel informed, empowered, and supported. I also aim to ensure that newborns are not subjected to unnecessary procedures and that we practice in a way that offers true benefit and gentle, loving care for every child that we welcome into our practice.

What Are Tongue-Ties and Lip-Ties?

Ankyloglossia, or a tongue-tie, occurs when the thin tissue band under the tongue (lingual frenum or frenulum) which attaches the tongue to the floor of the mouth is unusually short, thick, or tight, potentially challeging tongue movement.

The band of tissues that attaches the upper lip to the gum pads is what forms the labial frenum or frenlum. Similarly, a lip tie refers to a tight, thick, or restrictive upper lip frenum. Restrictive tissues can also be refered to as “tethered oral tissues” or TOTS.

Tongue ties and lip ties during infancy have been associated with:

• Breastfeeding difficulties
• Nipple pain or trauma for mothers
• Clicking or ineffective suckling
• Poor milk transfer
• Infant weight gain challenges
• Potential oral development concerns

Other potential issues that have been linked to restrictive frenula during childhood years and beyond include:

• Challenges with cleaning the upper front teeth, placing them at risk for tooth decay
• Speech development concerns
• Airway, breathing and swallowing quality
• Gapping between the two front teeth (also known as a diastema) and orthodontic needs
• Food sensitivities or aversions to sticky foods that cannot be cleared from the mouth due to limited tongue mobility
• Long-term periodontal tissue quality for teeth near the sites of extensive frenulum tension

How Are Tongue-Ties and Lip-Ties Diagnosed?

Mindful diagnosis of lip and tongue ties requires close assessment of the functionality of the tissues rather than visual classifications. Even with a true tongue or lip tie, where the frenula are very tight, short, or restrictive, there are cases where no major problem with breastfeeding is ever noted.

A sound understanding of normal anatomy is necessary because oral tissues vary in appearance and normalcy and are ever remodeling as infants grow and mature. Diagnosis in toddlers and children tends to be easier as further growth occurs, teeth erupt, and the oral tissues settle into place.

Understanding the Terms: Frenotomy vs. Frenectomy vs. Frenuloplasty

To understand the different terms used to describe procedures on the oral frenula, the American Academy of Pediatric Dentistry (AAPD) offers the following distinctions:

• Frenotomy (or Frenulotomy):

A Frenotomy is the most commonly performed procedure in infants. It involves a simple incision or release of the frenum to free restricted movement. Often performed with scissors or a dental laser, an infant tonge-tie release or an infant lip procedure is a quick, minimally invasive procedure designed to improve tongue or lip mobility when functionally indicated.

• Frenectomy:

The term frenectomy or frenulectomy has been commonly used in parental online forums to refer to what is really an infant frenotomy procedure. A true pediatric frenectomy is a more involved procedure that entails full removal of the frenum tissue.

Frenectomies are typically reserved for older children or adolescents when the frenum contributes to orthodontic challenges (such as gaps between the teeth), speech issues, or recurrent tissue trauma. Complete removal may also the last resort if a simple release is insufficient.

• Frenuloplasty:

This is a more involved surgical reconstruction of the frenum. It may be used when the tissue is especially thick, scarred, or requires repositioning. Sutures are often placed to promote healing in a more favorable anatomical position. Frenuloplasty is rarely needed for infants.

It is reserved for very select cases where structural or breathing anamolies are noted.

In our practice, gentle infant frenotomies and mindful pediatric frenulectomies are performed using our advanced Solea CO2 laser technology, ensuring precise release with minimal discomfort and rapid healing.

Why Are So Many Frenectomies Being Performed on Infants?

According to studies published in JAMA Otolaryngology and data reviewed by the American Academy of Pediatrics (AAP), The number of frenotomy procedures has risen exponentially over the last decade. Some studies report increases of several hundred percent over the past decade, with certain specialty centers observing rises of up to 500% or more.

This rapid rise has sparked important conversations within the pediatric medical, dental and lactation communities.

The American Academy of Pediatric Dentistry (AAPD), including its current Task Force on Tethered Oral Tissues, is actively reviewing available evidence to better define clear guidelines for when these procedures are necessary and when they may not be.

What Does the Research Say?

Several well-designed studies, including systematic reviews and Cochrane analyses, suggest that for some breastfeeding pairs, particularly those experiencing severe latch difficulties and maternal nipple pain, a carefully performed tongue-tie release may improve comfort and feeding mechanics in the short term.

• The 2017 Cochrane Review (O’Shea et al.) concluded that frenotomy may reduce nipple pain for mothers experiencing feeding challenges.
• However, long-term benefits for breastfeeding duration, speech outcomes, and growth remain less definitively supported by convincing evidence.
• Data for lip-tie procedures is even more limited and largely based on clinical judgment and emerging research.

Importantly, both the AAP and AAPD emphasize that treatment decisions should prioritize function over appearance. A visible frenum does not always equal a restrictive tie.

Many infants with apparent ties breastfeed successfully without intervention when provided with expert lactation support.

Compassionate Care for Families

1-Breastfeeding is an emotional journey. For parents facing feeding difficulties, the decision of whether to pursue a frenulotomy can feel overwhelming. It is essential to acknowledge:

• Your experience is real
• Your frustrations are valid
• You deserve support, not judgment
• Your baby is loved no matter what
• You are doing your best as a caring parent
• It is completely normal (and highly encouraged) to look for all the support you can get
• Get more than one opinion and reach out to knowledgeable professionals
• Accept family (and friends) support in all forms

2- For parents of children and teens that have a lip or a tongue tie and wish to explore the benefits of addressing the frenulum tissues, we will be exploring:

• Position and type of frenulum tissues
• The benefits and timing of a frenulecomty:
  • Lip tie procedure timing: Ideally before the upper front primary incisors are switched into permanent incisors. This helps to enhance the natural tissue remodeling that occurs at this stage of development
  • Tongue tie procedure timing: Once speech and myofucnationl therapy sessions have been established so that they continue after the procedure. This will ensure maximum benefit to the child and increase the chances of overall success

3-The procedure:

Using our Solea laser, frenulotomies and frenulectomies are completed swiftly and easily with high percision and meticulous accuracy. For infants, we typically rely soley on a strong compound topical anesthetic. Most babies can breastfeed immediately right after the procedure. In fact, we hightly encourage this for both baby’s and mother’s soothing and to assess the breastfeeding process post frenulotomy.

For children, we will usually add a few drops of local anesthetic using our computerized dental anesthesia delivery system (The STA) and offer sedation options to augment comfort. The actual surgical time is truly short, with the procedure being completed in under a minute for infants and in a few minutes for children and teens. The Solea unit ensures no bleeding, clean tissue ablation and accelerated post operative healing. No sutures are typically needed.

4- What to expect after a frenulotomy/frenulecomty:

When a mindful decision is taken to move forward with a frenulotomy/frenulectomy, it is incredibly important that proper home care and follow-up instructions be explained in detail to parents. This is becuase the success of the proedure highly relies on follow-up care.

For infants, the site of the frenotomy requires daily stretches and wound care. Parents are taughts to gently run a clean finger between the upper lip and the gum pads and under the infant’s tongue to help the tissues heal in the correct position rather than reattach with scar tissue. Infant oral tissues have an extremely high healng capacity. Without these daily physical manipulations, that require deligance and complince, it is not uncommon for untended tissues to reattach in their original position.

For older children, gentle oral hygiene and soft diet choices are key. In general, the procedure is well tolerated and post operative discomfort is mild to minimal. Cold thermal therapy is remarkably effective in calming the tissues. Minor doses of Tylenol or Motrin can also be used if needed. We recommend that speech therapy and myofuncitonal visits be resumed as soon as possible to aid in proper, functional healing.

4-The best outcomes of frenulotomies and frenulectomies result from collaborative care, including:

• Experienced pediatricians, pediatric dentists, ENT specialists and body workers
• International Board-Certified Lactation Consultants (IBCLCs)
• Feeding therapists, speech therapists and myofunctional specialists

Every baby is unique, and every treatment plan should reflect your child’s and family’s individual needs and honor you, the loving parents as well as your baby.

My Approach as a Board-Certifed Pediatric Dentist:

In our west los angeles pediatric and orthodontic dental practice, we evaluate each child thoughtfully considering the family dynamic and the specific concerns of parents. Our mindful assessment includes:

• A visual and functional oral assessment
• Infant/child health and feeding patterns
• Parental and family support
• Collaborative input from other specialists liked lactation consultants and pediatricians

Not every tongue or lip tie requires release. In fact, many can be observed and monitored for future changes if the breastfeeding mother finds the support that she needs in altrnative ways. Also, if speech and myofunctional specialists succeed in improving a child’s articulation and oral functions, there may not be a need for surgical intervention.

The idea of “mindful intervention” is a super important one as we learn more about long term changes for infants and children who are undergoing these procedures now.

When intervention is truly needed, the goal is to achieve notable improvements with excellent healing. We aim for a high success rated with limited postoperative challenges.

Feedback from breastfeeding mothers should report much relief in both breastfeeing, infant/mother bonding and overall baby comfort. In children, oral tissues should heal esthetically, orthodonic spacing should be easy to resolve and long-term periodontal health be estalished.

Speech therapy should also progress at an improved rate. For these goals to be met, a sound foundation of communication, clear expectation and full commitment is needed from the parents and all involved practitioners.

Our Magical Solea Laser:

Solea is a state-of-the-art CO2 laser technology that is an excellent instrument to achieve successful and efficient frenulotomies/frenulectomies. Solea reshapes this surgical procedure with:

• Minimal discomfort
• Minimal to no bleeding
• No sutures
• Precise control
• Short procedure times
• Rapid healing

Where Does the Professional Community Stand Today?

While much has been learned, much is still under study. The American Academy of Pediatrics, the American Academy of Pediatric Dentistry, and a growing body of researchers continue to investigate:

• When early intervention is most beneficial
• How to define true functional restriction
• The long-term developmental impact of tethered oral tissues
• The long-term impact of performed frenulotomies/Frenectomies

This ongoing work reflects both the complexity of the issue, and the medical community’s commitment to offering parents the most ethical, evidence-based care possible.

You Are Not Alone

Mothers, if you are struggling with breastfeeding, or simply have concerns about your baby’s oral development, I invite you to schedule a consultation. Together, we can explore your baby’s needs, review all options, and create a care plan grounded in both science and compassion so you and your newborn can thrive in ease, joy, and comfort.

Parents and families, if you are wondering about your child’s speech, the appearance of their smile, dental spacing or orthodontic management, we would love to meet you and review mindful options.

Tongue-tie and lip-tie in infants and children with evidence-based ankyloglossia assessment, frenotomy/frenulecomty procedures, and breastfeeding solutions. Compassionate care for feeding difficulties, nipple pain, and latch problems supporting mothers and babies. Growth monitoring for tethered oral tissues in children. Guided by Dr. Reem Kabbarah, expert pediatric dentist in West Los Angeles.